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[Appendicitis in the elderly. CRP value as decision support for diagnostic laparoscopy]
D Sülberg1, A M Chromik, S Kersting
1Chirurgische Klinik, St. Josef-Hospital, Klinikum der Ruhr-Universität, Gudrunstrasse 56, Bochum, Germany.
Summary
Elderly patients with appendicitis often present with delayed diagnosis and poorer outcomes. A C-reactive protein (CRP) level over 102 mg/l in older adults strongly indicates perforation, warranting early diagnostic laparoscopy.
Area of Science:
- General Surgery
- Gastroenterology
- Geriatric Medicine
Context:
- Diagnosing acute appendicitis in elderly patients presents challenges due to atypical presentations and a wide differential diagnosis.
- Delayed diagnosis in this demographic can lead to severe complications and adverse outcomes.
- This study addresses the need for improved diagnostic strategies in geriatric appendicitis.
Purpose:
- To investigate the clinical characteristics of appendicitis in patients over 60 years old.
- To identify factors that facilitate earlier diagnosis and intervention in elderly patients with appendicitis.
- To evaluate the utility of inflammatory markers, specifically C-reactive protein (CRP), in diagnosing appendicitis complications in the elderly.
Summary:
- A prospective study of 403 appendectomies revealed that 11.2% of patients were over 60.
- Elderly patients (>60 years) experienced significantly higher rates of perforation (35.6%), peritonitis (42.2%), conversion to open surgery (23%), and complications (28.9%) compared to younger patients.
- Elevated C-reactive protein (CRP) levels (average 123.2 mg/l) were significantly higher in elderly patients, with a CRP cut-off of 101.9 mg/l effectively predicting perforation (AUC 0.811).
Impact:
- The findings highlight the increased risk of severe appendicitis and complications in the elderly population.
- A C-reactive protein (CRP) threshold of 102 mg/l is proposed as a critical indicator for prompt surgical evaluation in elderly patients with suspected appendicitis.
- Early diagnostic laparoscopy is recommended for elderly patients presenting with appendicitis symptoms and elevated CRP levels to improve outcomes.
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