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C-reactive protein estimation does not improve accuracy in the diagnosis of acute appendicitis in pediatric patients
Elizabeth Kim1, Gokulakkrishna Subhas, Vijay K Mittal
1Department of General Surgery, Providence Hospital and Medical Centers, Southfield, MI 48075, USA.
Insights
White blood cell (WBC) counts are more sensitive and specific for diagnosing appendicitis in children than C-reactive protein (CRP) levels. Our findings suggest WBC is a more reliable indicator for pediatric appendicitis diagnosis.
Area of Science:
- Pediatric Surgery
- Diagnostic Imaging
- Clinical Pathology
Background:
- Appendectomy is the standard treatment for acute appendicitis in children.
- Delayed diagnosis can lead to complications such as perforation.
- Existing studies on the diagnostic utility of WBC and CRP show conflicting results.
Purpose of the Study:
- To evaluate the diagnostic role of C-reactive protein (CRP) in pediatric appendicitis.
- To compare the diagnostic value of CRP with white blood cell (WBC) counts.
Main Methods:
- A retrospective chart review of 130 pediatric patients (<19 years) who underwent appendectomy between 2002-2006.
- Histological examination classified appendicitis as simple or perforated (complicated).
Main Results:
- White blood cell (WBC) count demonstrated the highest sensitivity (88%) for appendicitis diagnosis.
- C-reactive protein (CRP) had a sensitivity of 69%, and the combination of WBC and CRP was 60%.
- Positive predictive value (PPV) for WBC was higher than CRP for both simple and perforated appendicitis.
Conclusions:
- WBC counts are more sensitive and have a higher PPV than CRP for diagnosing appendicitis in children.
- CRP does not significantly aid in the diagnosis of appendicitis, alone or in combination with WBC.
- Simple appendicitis can occur even with normal WBC and CRP levels.
Background:
Appendectomy is the treatment of choice in acute appendicitis in children. Delayed diagnosis of acute appendicitis in children can lead to complications like perforation. Studies on the diagnostic value of WBC and CRP in establishing the diagnosis of appendicitis have contradictory results. Our study evaluates the role of CRP in diagnosing appendicitis in a pediatric population.
Methods:
A retrospective chart study on 130 patients aged less than 19 years who had an appendectomy at Sparrow hospital during years 2002-2006 formed the basis for this report. Based on histology appendicitis was classified as simple or perforated (complicated).
Results:
Patients (75 boys, 55 girls) were 6-18 years of age (median 14 years). The appendix was normal in 9/130 cases. Appendicitis was simple in 58/130 cases and perforated in 63/130 cases. Overall WBC count had the highest sensitivity in the prediction of (diagnosis) appendicitis at 88% whereas CRP was 69% and, WBC and CRP combined was 60%. PPV of WBC was highest at 0.81 (47/58) for simple appendicitis and 0.93 (59/63) for perforated appendicitis, when compared to CRP at 0.57 (33/58) and 0.81 (51/63); and CRP and WBC combined at 0.45 (26/58) and 0.75 (47/63).
Conclusion:
The sensitivity and PPV of WBC were better than CRP alone, or in combination with WBC. We conclude that CRP does not aid in the diagnosis of appendicitis. Simple appendicitis was seen in spite of normal WBC and CRP.
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