title: Use of changes over time in serum inflammatory parameters in patients with equivocal appendicitis.
abstract: BACKGROUND
  The aim of this prospective study was to determine whether the change between the initial and subsequent analysis of serum inflammatory markers measured 6 to 10 hours later could improve diagnostic accuracy in appendicitis.
  
  
  METHODS
  The study group comprised 225 patients who presented to hospital with equivocal signs of appendicitis from 2003 to 2004. Based on the period from the onset of symptoms to admission, receiver operating characteristic (ROC) curves were used to determine cutoff values of the changes between primary and repeated laboratory examinations in diagnosing appendicitis.
  
  
  RESULTS
  ROC analysis showed that the cutoff values for the change in total percentage neutrophil count on the first day after onset of symptoms (3.2%), and a change of in CRP concentration above the baseline on the second day (9.5 mg/L) and the third day (17.0 mg/L) after onset of symptoms were significant parameters for diagnosing acute appendicitis.
  
  
  CONCLUSIONS
  The cutoff values of the change in total neutrophil count on the first day after onset of symptoms and the change in CRP on the second and third days after onset of symptoms during in-hospital observation may serve as useful parameters to surgeons in differentiating acute appendicitis from other acute abdominal diseases.
authors.affiliation: Department of Emergency Medicine, Chang Jung Christian University, Changhua, Taiwan.
authors.forename: Han-Ping
authors.initials: HP
authors.lastname: Wu
authors.forename: Chin-Yi
authors.initials: CY
authors.lastname: Huang
authors.forename: Yu-Jun
authors.initials: YJ
authors.lastname: Chang
authors.forename: Chu-Chung
authors.initials: CC
authors.lastname: Chou
authors.forename: Ching-Yuang
authors.initials: CY
authors.lastname: Lin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001064:Appendicitis / Q000097:blood* / Q000000981:diagnostic imaging; D002097:C-Reactive Protein / Q000032:analysis*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012372:ROC Curve; D011859:Radiography; D013997:Time Factors; D014463:Ultrasonography
chemical_list: D002097:C-Reactive Protein