Inflammatory markers for acute appendicitis in children: are they helpful?
OBJECTIVE
Diagnosis of acute appendicitis in children remains challenging, and the role of blood tests in the decision-making process is still unclear. We prospectively evaluated if routine inflammatory markers could contribute to exclude the presence of acute appendicitis in children.


METHODS
Preoperative white blood cell count (WBCC) and C-reactive protein (CRP) were prospectively tested in children undergoing surgery for suspected appendicitis. Surgery was indicated on the basis of clinical findings and/or ultrasound scan, but WBCC and CRP values were ignored during the decision-making process. Sensitivity of individual markers and their combinations were assessed.


RESULTS
One hundred children (55 males) with a mean age of 9.34 years (SD, 3.54 years) had pathologically confirmed diagnosis of appendicitis. A perforated appendix was found in 23% of cases. Elevated WBCC alone had a sensitivity of 0.6 (confidence interval [CI], 0.506-0.694). Sensitivity of elevated CRP alone was 0.86 (CI, 0.926-0.793). Elevation of either WBCC or CRP or both had a sensitivity of 0.98 (CI, 1.0-0.953).


CONCLUSIONS
White blood cell count or CRP values alone do not appear to provide any useful additional information to the surgeon. However, the sensitivity of the 2 combined tests is extremely high, and normal values of both WBCC and CRP are very unlikely in pathologically confirmed appendicitis.
Stefanutti
Giorgio
G
Paediatric Surgery Unit, University of Padova, 35121 Padova, Italy.
Ghirardo
Vittorina
V
Gamba
Piergiorgio
P
D000208:Acute Disease; D001062:Appendectomy; D001064:Appendicitis / Q000097:blood* / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D015415:Biomarkers / Q000097:blood*; D002097:C-Reactive Protein / Q000378:metabolism*; D002648:Child; D005260:Female; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D011446:Prospective Studies; D012680:Sensitivity and Specificity
D015415:Biomarkers; D002097:C-Reactive Protein