title: Predictive value of C-reactive protein, ultrasound and Alvarado score in acute appendicitis: a prospective pediatric cohort.
abstract: OBJECTIVE
  To evaluate whether C-reactive protein (CRP) level and ultrasound (US) results on admission could aid the diagnostic accuracy of Alvarado score.
  
  
  METHODS
  A prospective study was performed on children <14 years admitted for suspected acute appendicitis. Patients were categorized into three groups based on the Alvarado score: group I: score 7-10, group II: score 5-6, group III: score 0-4.
  
  
  RESULTS
  The difference between predictive values of Alvarado score alone and Alvarado score with CRP was not statically significant. The PPV increased from 74.29% (Alvarado score and CRP) to 93.75% (Alvarado score and US) in group 1 (P = .001) and the NPV increased from 64.86 and 79.69% (Alvarado score and CRP) to 82.6 and 88.2% (Alvarado score and US) in group 2 (P = .01) and group 3 (P = .001), respectively.
  
  
  CONCLUSIONS
  Alvarado score and ultrasound taken together improve the predictive value of diagnosing acute appendicitis in children.
authors.affiliation: Department of pediatric surgery, Hedi Chaker Hospital, 3029 Sfax, Tunisia. Electronic address: zouarimohamed.1982@yahoo.fr.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Zouari
authors.affiliation: Department of pediatric surgery, Hedi Chaker Hospital, 3029 Sfax, Tunisia.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Jallouli
authors.affiliation: Department of pediatric surgery, Hedi Chaker Hospital, 3029 Sfax, Tunisia.
authors.forename: Hamdi
authors.initials: H
authors.lastname: Louati
authors.affiliation: Department of pediatric surgery, Hedi Chaker Hospital, 3029 Sfax, Tunisia.
authors.forename: Rim
authors.initials: R
authors.lastname: Kchaou
authors.affiliation: Department of pediatric surgery, Hedi Chaker Hospital, 3029 Sfax, Tunisia.
authors.forename: Rahma
authors.initials: R
authors.lastname: Chtourou
authors.affiliation: Department of pediatric surgery, Hedi Chaker Hospital, 3029 Sfax, Tunisia.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Kotti
authors.affiliation: Department of pediatric surgery, Hedi Chaker Hospital, 3029 Sfax, Tunisia.
authors.forename: Mahdi Ben
authors.initials: MB
authors.lastname: Dhaou
authors.affiliation: Department of pediatric surgery, Hedi Chaker Hospital, 3029 Sfax, Tunisia.
authors.forename: Hayet
authors.initials: H
authors.lastname: Zitouni
authors.affiliation: Department of pediatric surgery, Hedi Chaker Hospital, 3029 Sfax, Tunisia.
authors.forename: Riadh
authors.initials: R
authors.lastname: Mhiri
mesh_terms: D000293:Adolescent; D001064:Appendicitis / Q000097:blood* / Q000000981:diagnostic imaging*; D002097:C-Reactive Protein / Q000378:metabolism*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D014463:Ultrasonography
chemical_list: D002097:C-Reactive Protein