Coagulation Profile: Alterations and Diagnostic Yield in Pediatric Acute Appendicitis: A Prospective Validation Study

Area of Science:

• Pediatric Surgery
• Hematology
• Diagnostic Medicine

Background:

• Limited research exists on coagulation profile changes in pediatric acute appendicitis (PAA).
• Previous studies primarily focused on fibrinogen, with scarce data on other coagulation parameters.

Purpose of the Study:

• To prospectively investigate coagulation profile alterations in pediatric patients with acute appendicitis.
• To evaluate the diagnostic performance of various coagulation parameters in differentiating PAA from non-surgical abdominal pain and complicated from non-complicated PAA.

Main Methods:

• A prospective study involving 151 pediatric patients (53 non-surgical abdominal pain, 98 PAA).
• Coagulation parameters including international normalized ratio (INR), activated partial thromboplastin time (aPTT), d-dimer, platelets, mean platelet volume, and platelet-to-lymphocyte ratio were analyzed.
• Diagnostic yield was assessed using receiver operating characteristic (ROC) curves.

Main Results:

• Patients with PAA exhibited higher median levels of INR, fibrinogen, and d-dimer compared to those with non-surgical abdominal pain.
• Complicated PAA cases showed significantly higher median INR and fibrinogen values.
• Fibrinogen demonstrated the highest diagnostic yield for distinguishing PAA from non-surgical abdominal pain (AUC, 0.74) and complicated from non-complicated PAA (AUC, 0.71).

Conclusions:

• Pediatric acute appendicitis is associated with a moderate extrinsic pathway coagulopathy, more pronounced in complicated cases.
• Fibrinogen serves as a valuable parameter with moderate diagnostic utility for PAA diagnosis and severity assessment.