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Appendicitis in paediatric age group: correlation between preoperative inflammatory markers and postoperative
Peter Mekhail1, Nader Naguib, Fady Yanni
1Department of Surgery, Aintree University Hospital, Liverpool, United Kingdom. petertadros@hotmail.com
Insights
Preoperative inflammatory markers like C-reactive protein (CRP) and white blood cell count (WBCC) aid in diagnosing appendicitis in children. These simple tests support clinical judgment, improving diagnostic accuracy for pediatric appendicitis.
Area of Science:
- Pediatric Surgery
- Diagnostic Imaging
- Clinical Pathology
Background:
- Appendicitis diagnosis in children is challenging, with higher perforation risks.
- A sensitive and specific diagnostic tool is crucial for pediatric appendicitis.
Purpose of the Study:
- To evaluate the utility of preoperative inflammatory markers in diagnosing pediatric appendicitis.
- Assessing the role of C-reactive protein (CRP) and white blood cell count (WBCC) in supporting clinical diagnosis.
Main Methods:
- Retrospective analysis of 268 pediatric appendectomies over seven years.
- Collected data included preoperative CRP, WBCC, and postoperative histology.
- Statistical analysis utilized Fisher's exact test.
Main Results:
- Histology confirmed appendicitis in 75.4% of cases.
- CRP sensitivity was 82% (specificity 60%), WBCC sensitivity 80% (specificity 59%).
- Combined markers showed 80% sensitivity and 70% specificity.
Conclusions:
- CRP and WBCC are valuable, simple tests supporting acute appendicitis diagnosis in pediatric patients.
- These inflammatory markers assist clinicians in making more accurate diagnoses.
Introduction:
Clinical diagnosis of appendicitis can be challenging, particularly in the paediatric age group. There is an increased risk of perforation in paediatrics; therefore, a need for sensitive and specific diagnostic tool is mandatory.
Aim:
The aim of this study is to evaluate the role of preoperative inflammatory markers in supporting the clinical diagnosis of appendicitis in the paediatric age group.
Materials And Methods:
Retrospective study of 268 emergency paediatric appendicectomies performed in a District General Hospital in Wales, over a period of seven years (2002-2009). The data collected from hospital database include preoperative inflammatory markers, C-reactive protein (CRP) and white blood cells count (WBCC) and post-operative histology. Statistical analysis was performed using Fisher's exact test.
Results:
The median age group in the study was 12 (2-16). 141 (53%) patients were <12 years, while 127 (47%) patients were 12-16 years old. Male : female ratio = 1 : 1 (134 each). Inflammatory markers were not done for 94 patients (35%). CRP was done for 149 cases (55.6%), while WBCC was done for 172 cases (64%). Both markers were done together for 147 cases (54.8%). Histology was positive (inflamed / gangrenous appendix) in 202 cases (75.4%). Eight cases were associated with Enterobious vermicularis infestation and one patient had carcinoid tumour. The sensitivity and specificity of CRP were 82% and 60%, respectively, with positive predictive value (PPV) of 87% (P<0.0001), while those of WBCC were 80% and 59%, respectively, with PPV of 88% (P<0.0001). The sensitivity and specificity of both markers together were 80% and 70%, respectively, with PPV= 81% (P = 3.11E-8). 94 patients (35%) had an appendicectomy operation based on clinical diagnosis alone without preoperative inflammatory markers having been tested. In 28 cases (30%) out of these, postoperative histology revealed normal appendix (P = 0.18).
Conclusion:
CRP and WBCC are simple tests that can provide a significant role supporting the clinical diagnosis of acute appendicitis in the paediatric age group.
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