Use of changes over time in serum inflammatory parameters in patients with equivocal appendicitis

The Systemic Inflammatory Response in Patients with Appendicitis: a Progressive Phenomenon

“…With an increased interval between the onset of symptoms and surgery exceeding 72 h, the odds for more severe pathology were higher compared with an interval below 12 h [2,3,5,6,11,12], and this observation was confirmed with the findings of the present study showing increased SIRS scores and diagnostic intervals related to an increased rate of perforated appendicitis. Patient delay in presenting to the emergency room after onset of symptoms was related to worsening pathology compared with in-hospital delays [11].…”

“…The importance of prompt diagnosis and treatment for patients with appendicitis has been emphasized in order to avoid septic complications that increase with advanced pathology [2,5,11,12]. With an increased interval between the onset of symptoms and surgery exceeding 72 h, the odds for more severe pathology were higher compared with an interval below 12 h [2,3,5,6,11,12], and this observation was confirmed with the findings of the present study showing increased SIRS scores and diagnostic intervals related to an increased rate of perforated appendicitis.…”

“…Patient delay in presenting to the emergency room after onset of symptoms was related to worsening pathology compared with in-hospital delays [11]. However, although these data support the importance of progressive inflammatory reaction to appendicitis, the proper inflammatory progression has not been characterized [12]. This is of relevance because of recent claims for conservative antibiotic management of appendicitis [13][14][15][16][17][18][19], the high rate of conservative treatment failure, and recurrent appendicitis indicating a problem with the design of these studies which have used unselected consecutive samples with various different diagnostic intervals, not taking into account the fact that appendicitis is an evolving disease that worsens with the passing of time.…”

“…Although the absence of leukocytosis does not rule out appendicitis [3,21], its presence supports the clinical diagnosis [2][3][4][5][6][7][8]20]. It is expected that patients with advanced disease have higher WBC count due to increased polymorphonuclear cell count [5,12,20]. However, once the septic process is established, leukopenia may ensue.…”

Diagnosis of Acute Appendicitis Using Scoring System: Compared with the Alvarado Score

“…(17)(18)(19) Recently, Andersson and Andersson (18) reported that vomiting, tenderness, rebound tenderness, body temperature, neutrophil proportion, white blood cell count and CRP concentration are adopted, which supports the approach taken in the present study.…”