title: Discriminative accuracy of novel and traditional biomarkers in children with suspected appendicitis adjusted for duration of abdominal pain.
abstract: OBJECTIVE
  The objective was to assess the accuracy of novel and traditional biomarkers in patients with suspected appendicitis as a function of duration of symptoms.
  
  
  METHODS
  This was a prospective cohort study, conducted in a tertiary care emergency department (ED). The authors enrolled children 3 to 18 years old with acute abdominal pain of less than 96 hours and measured serum levels of interleukin-6 (IL-6), interleukin-8 (IL-8), C-reactive protein (CRP), white blood cell (WBC) count, and absolute neutrophil count (ANC). Final diagnosis was determined by histopathology or telephone follow-up. Trends in biomarker levels were examined based on duration of abdominal pain. The accuracy of biomarkers was assessed with receiver operating characteristic (ROC) curves. Optimal cut-points and test performance characteristics were calculated for each biomarker.
  
  
  RESULTS
  Of 280 patients enrolled, the median age was 11.3 years (interquartile range [IQR] = 8.6 to 14.8), 57% were male, and 33% had appendicitis. Median IL-6, median CRP, mean WBC count, and mean ANC differed significantly (p < 0.001) between patients with nonperforated appendicitis and those without appendicitis; median IL-8 levels did not differ between groups. In nonperforated appendicitis, median IL-6, WBC, and ANC levels were maximal at less than 24 hours of pain, while CRP peaked between 24 and 48 hours. In perforated appendicitis, median IL-8 levels were highest by 24 hours, WBC count and IL-6 by 24 to 48 hours, and CRP after 48 hours of pain. The WBC count appeared to be the most useful marker to predict appendicitis in those with fewer than 24 or more than 48 hours of pain, while CRP was the most useful in those with 24 to 48 hours of pain.
  
  
  CONCLUSIONS
  In this population, the serum levels and accuracy of novel and traditional biomarkers varies in relation to duration of abdominal pain. IL-6 shows promise as a novel biomarker to identify children with appendicitis.
authors.affiliation: Division of Pediatric Emergency Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA. abk@umn.edu
authors.forename: Anupam B
authors.initials: AB
authors.lastname: Kharbanda
authors.forename: Yohaimi
authors.initials: Y
authors.lastname: Cosme
authors.forename: Khin
authors.initials: K
authors.lastname: Liu
authors.forename: Steven L
authors.initials: SL
authors.lastname: Spitalnik
authors.forename: Peter S
authors.initials: PS
authors.lastname: Dayan
mesh_terms: D015746:Abdominal Pain / Q000175:diagnosis*; D000293:Adolescent; D001064:Appendicitis / Q000175:diagnosis*; D015415:Biomarkers / Q000097:blood*; D002097:C-Reactive Protein / Q000032:analysis; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D015850:Interleukin-6 / Q000097:blood*; D016209:Interleukin-8 / Q000097:blood; D007958:Leukocyte Count; D008297:Male; D010865:Pilot Projects; D012372:ROC Curve; D012680:Sensitivity and Specificity; D055815:Young Adult
chemical_list: D015415:Biomarkers; D015850:Interleukin-6; D016209:Interleukin-8; D002097:C-Reactive Protein