title: Inflammatory markers for acute appendicitis in children: are they helpful?
abstract: 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.
authors.affiliation: Paediatric Surgery Unit, University of Padova, 35121 Padova, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Stefanutti
authors.forename: Vittorina
authors.initials: V
authors.lastname: Ghirardo
authors.forename: Piergiorgio
authors.initials: P
authors.lastname: Gamba
mesh_terms: 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
chemical_list: D015415:Biomarkers; D002097:C-Reactive Protein