title: Discriminant analysis of serum inflammatory biomarkers which differentiate pediatric appendicitis from other acute abdominal diseases.
abstract: 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.
authors.affiliation: Department of Emergency Medicine, Changhua Christian Hospital, Changhua, Taiwan .
authors.forename: Kung-Chen
authors.initials: KC
authors.lastname: Lin
authors.forename: Han-Ping
authors.initials: HP
authors.lastname: Wu
authors.forename: Chin-Yi
authors.initials: CY
authors.lastname: Huang
authors.forename: Ching-Yuang
authors.initials: CY
authors.lastname: Lin
authors.forename: Chin-Fu
authors.initials: CF
authors.lastname: Chang
mesh_terms: 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
chemical_list: D015415:Biomarkers; D002097:C-Reactive Protein