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[The value of C-reactive protein in the diagnosis of acute appendicitis in children]
F Calvo Rigual1, S Sendra Esteve, A Mialaret Lahiguera
1Servicio de Pediatria, Hospital Lluis Alcanyís, Valencia.
Insights
C-reactive protein (CRP) and white cell count aid in diagnosing appendicitis, especially when symptoms exceed 12 hours. Combining these tests improves diagnostic accuracy for acute appendicitis.
Area of Science:
- Pediatric Surgery
- Clinical Chemistry
Context:
- Acute appendicitis is a common surgical emergency in children.
- Accurate diagnosis is crucial to avoid complications and unnecessary surgery.
- Biomarkers like C-reactive protein (CRP) and white cell count (WCC) are frequently used.
Purpose:
- To evaluate the diagnostic utility of C-reactive protein (CRP) levels, alone and combined with total white cell count (WCC), for acute appendicitis in children.
- To compare the effectiveness of these markers based on symptom duration.
Summary:
- This study analyzed 231 children with suspected appendicitis.
- Elevated CRP levels and WCC were significantly associated with appendicitis.
- CRP was particularly useful for symptom durations over 12 hours, while WCC was more valuable for shorter durations.
- Combining CRP and WCC enhanced diagnostic predictive values.
Impact:
- C-reactive protein measurement is a valuable tool in diagnosing acute appendicitis, especially in cases with prolonged symptoms.
- The combined use of CRP and white cell count improves the overall diagnostic accuracy for appendicitis.
- These findings can help refine diagnostic strategies for pediatric appendicitis.
Objective:
The aim of this study was to evaluate the usefulness of C-reactive protein values in the diagnosis of acute appendicitis, either as a single test or in combination with total white cell count.
Patients And Methods:
Two hundred and thirty-one children with suspected appendicitis were analyzed. C-reactive protein and total white cell counts were measured and compared with the duration of symptoms and histological diagnosis. Both tests were compared by receiver-operating characteristic curves and the probability for the use of both tests together was calculated.
Results:
Ninety out of 231 patients had abdominal pain that did not demand surgery. One hundred and forty-one children had histologically confirmed appendicitis (subgroups: 101 acute, 25 gangrenous and 15 perforated appendices). Mean C-reactive protein levels at admission were 25.1, 55 and 66.7 mg/L, respectively in these histological subgroups and 14.9 mg/L in the non-appendicitis group (p < 0.001). The total white cell count was also statistically significant. Both tests were equally valuable in patients whose symptoms had a duration of more than 12 hours. The total white cell count was more valuable in patients with less than 12 hours of symptoms. The likelihood ratio for appendicitis was 2.72 for a C-reactive protein greater than 20 mg/l and a total white cell count above 15,000/mm3. The likelihood ratio of not having appendicitis was 0.37 when both tests were below these values.
Conclusions:
Measurement of C-reactive protein is useful in the diagnosis of acute appendicitis, mainly in cases with more than 12 hours of evolution. The combined tests improved the predictive values.