Diagnostic Value of White Blood Cell and C-Reactive Protein in Pediatric Appendicitis.
Background. Acute appendicitis (AA) associated with acute phase reaction is the most prevalent disease which requires emergency surgery. Its delayed diagnosis and unnecessarily performed appendectomies lead to numerous complications. In our study, we aimed to detect the role of WBC and CRP in the exclusion of acute and complicated appendicitis and diagnostic accuracy in pediatric age group. Methods. Appendectomized patient groups were constructed based on the results of histological evaluation. The area under a receiver operating characteristic (ROC) curve (AUC) was performed to examine diagnostic accuracy. Results. When WBC and CRP were used in combination, based on cut-off values of ≥13.1 × 10(3)/μL for WBC counts and ≥1.17 mg/dL for CRP level, diagnostic parameters were as follows: sensitivity, 98.7%; specificity, 71.3%; PPV, 50.6%; NPV, 99.5%; diagnostic accuracy, 77.6%; LR(+), 3.44; LR(-), 0.017. AUC values were 0.845 (95% CI 0.800-0.891) for WBC and 0.887 (95% CI 0.841-0.932) for CRP. Conclusions. For complicated appendicitis, CRP has the highest degree of diagnostic accuracy. The diagnosis of appendicitis should be made primarily based on clinical examination, and obviously more specific and systemic inflammatory markers are needed. Combined use of cut-off values of WBC (≥13100/μL) and CRP (≥1.17 mg/L) yields a higher sensitivity and NPV for the diagnosis of complicated appendicitis.
Department of Pediatric Surgery, Cengiz Gokcek Obstetrics and Children's Hospital, Sehitkamil, 27560 Gaziantep, Turkey.
Sevgi
S
Buyukbese Sarsu
Department of Pediatric Surgery, Haseki Training and Research Hospital, 34440 Istanbul, Turkey.
Fatma
F
Sarac
D015746:Abdominal Pain / Q000175:diagnosis; D000208:Acute Disease; D000293:Adolescent; D001064:Appendicitis / Q000097:blood* / Q000175:diagnosis*; D019540:Area Under Curve; D002097:C-Reactive Protein / Q000378:metabolism*; D002648:Child; D005260:Female; D006801:Humans; D007958:Leukocyte Count; D007962:Leukocytes; D008297:Male; D011237:Predictive Value of Tests; D012372:ROC Curve; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
D002097:C-Reactive Protein