title: Diagnostic accuracy of white cell count and C-reactive protein for assessing the severity of paediatric appendicitis.
abstract: OBJECTIVE
  Simple investigations like white cell count (WCC) and C-reactive protein (CRP) may help to improve the accuracy of diagnosis in paediatric appendicitis. We evaluated the diagnostic accuracy of WCC and CRP for the severity of acute appendicitis in children.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  This study was conducted on all children who underwent open appendectomy from January 2007 to December 2008 at a District General Hospital. Data regarding demographics, WCC, CRP, histology and postoperative complications were analysed.
  
  
  METHODS
  All children who underwent open appendectomy during the study period.
  
  
  METHODS
  Diagnostic accuracy of WCC and CRP for simple acute appendicitis and a perforated appendix.
  
  
  RESULTS
  Out of 204 patients, 112 (54.9%) were girls. At surgery, appendix was grossly inflamed in 175 of which 32 had perforation. Histology revealed simple acute appendicitis in 135 (66.2%) and gangrenous appendicitis in 32 (15.7%). The rest were normal. The duration of symptoms, temperature, length of stay, WCC and CRP were significantly worse in the perforated group (P value <0.05). Postoperative complications included wound infection (n = 18), pelvic collection (n = 5) and intestinal obstruction (n = 6); and were more common among patients with a perforated appendix (P value <0.05). WCC had a higher diagnostic accuracy and higher sensitivity than CRP in diagnosing simple acute appendicitis. The combined sensitivity of WCC and CRP increased to 95% and 100% for the diagnosis of simple acute appendicitis and a perforated appendix, respectively.
  
  
  CONCLUSIONS
  Accuracy of WCC is higher than CRP for diagnosing simple acute appendicitis. The combined sensitivity of WCC and CRP increases for simple acute appendicitis as well as a perforated appendix.
authors.affiliation: Department of General Surgery , William Harvey Hospital, Ashford, Kent , UK.
authors.forename: Khurram
authors.initials: K
authors.lastname: Siddique
authors.forename: Paramita
authors.initials: P
authors.lastname: Baruah
authors.forename: Santosh
authors.initials: S
authors.lastname: Bhandari
authors.forename: Shirin
authors.initials: S
authors.lastname: Mirza
authors.forename: Gandra
authors.initials: G
authors.lastname: Harinath