Discriminant analysis of serum inflammatory biomarkers which differentiate pediatric appendicitis from other acute abdominal diseases.
BACKGROUND
Other acute abdominal diseases in children can confound the signs and symptoms of appendicitis, resulting in misdiagnosis and unnecessary appendectomy. In this study, we used discriminant analysis of serum inflammatory biomarkers to determine which acute abdominal diseases could mimic appendicitis, and further analyzed these diseases based on different age groups.


METHODS
We prospectively collected 417 patients aged from 4 to 18 years with clinically suspected acute appendicitis in the pediatric emergency department. We selected the significantly higher serum biomarkers for appendicitis as the discriminating variables. Furthermore, we analyzed the definitive diagnoses of patients with normal appendices who could not be predicted by discriminant analysis.


RESULTS
Patients with acute appendicitis had significantly higher leukocyte counts (p < 0.01), neutrophil counts, (p < 0.01) and C-reactive protein concentrations (p < 0.01 ) than those with normal appendices. The discriminant power of these three serum biomarkers in acute appendicitis was 76 percent. Acute abdominal diseases which mimicked appendicitis included acute gastroenteritis, nonspecific abdominal pain, urinary tract infection, and upper respiratory infection with gastrointestinal upset.


CONCLUSIONS
Serum biomarkers may serve as helpful discriminators to predict the presence of pediatric appendicitis. But, some acute abdominal diseases mimicking appendicitis should be considered during differential diagnosis of acute appendicitis to avoid making misdiagnosis and performing unnecessary appendectomy.
Lin
Kung-Chen
KC
Department of Emergency Medicine, Changhua Christian Hospital, Changhua, Taiwan .
Wu
Han-Ping
HP
Huang
Chin-Yi
CY
Lin
Ching-Yuang
CY
Chang
Chin-Fu
CF
D015746:Abdominal Pain / Q000175:diagnosis; D000208:Acute Disease; D000293:Adolescent; D001064:Appendicitis / Q000175:diagnosis*; D015415:Biomarkers; D002097:C-Reactive Protein / Q000032:analysis*; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D005260:Female; D005759:Gastroenteritis / Q000175:diagnosis; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D011446:Prospective Studies; D014552:Urinary Tract Infections / Q000175:diagnosis
D015415:Biomarkers; D002097:C-Reactive Protein