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[Diagnostic value of reactive C protein in suspected acute appendicitis in children]
J Sánchez Echániz1, M Luis García, M A Vázquez Ronco
1Sección de Urgencias de Pediatría, Hospital Infantil de Cruces, Vizcaya.
Insights
C-reactive protein (CRP) levels can aid in diagnosing childhood acute appendicitis (AA). However, normal CRP values do not exclude simple appendicitis (SA), so surgery should not be denied based on CRP alone.
Area of Science:
- Pediatric Emergency Medicine
- Clinical Diagnostics
- Inflammatory Markers
Context:
- Acute appendicitis (AA) is a common surgical emergency in children.
- Accurate and timely diagnosis of AA is crucial to prevent complications.
- C-reactive protein (CRP) is a widely used inflammatory marker, but its diagnostic utility in pediatric AA requires further evaluation.
Purpose:
- To assess the diagnostic accuracy of C-reactive protein (CRP) measurements for suspected acute appendicitis (AA) in pediatric patients.
- To determine optimal CRP cut-off levels for identifying AA in children.
- To compare CRP levels across different pediatric abdominal pain etiologies.
Summary:
- A prospective study evaluated 195 children (2-14 years) with suspected AA.
- CRP levels were analyzed in relation to final diagnoses, including simple appendicitis (SA) and gangrenous appendicitis (GA).
- The study identified a CRP cut-off of 30 mg/L for AA with high specificity (0.92) but moderate sensitivity (0.43).
Impact:
- CRP levels are elevated in AA compared to other abdominal pain causes, but normal values can occur in SA.
- A CRP value exceeding 40 mg/L suggests gangrenous appendicitis (GA), warranting immediate surgical intervention and antibiotics.
- These findings refine the interpretation of CRP in pediatric AA diagnosis, guiding clinical decision-making and potentially improving patient outcomes.
Objective:
The aim of this study was to evaluate the accuracy of C-reactive protein (CRP) measurements in the diagnosis of suspected acute appendicitis (AA) during childhood.
Patients And Methods:
A prospective study of 195 consecutive children, aged between 2 and 14 years and suspected of having AA, that attended a pediatric emergency room was carried out. We obtained a careful patient history, physical signs, blood test results, final diagnosis and the histological findings in the cases who underwent appendectomy (classified as normal appendix, simple appendicitis (SA) or gangrenous appendicitis (GA).
Results:
The final diagnoses and their frequencies were: AA (94), non-specific abdominal pain (80), mesenteric lymphadenitis (6) and others (15). Appendectomies were performed in 103 cases with 94 cases being AA (91.3%) and of these 51 SA and 43 GA. The average values of CRP (mg/l) were: AA: 30, SA: 16, GA: 67, non-specific abdominal pain: 15, and mesenteric lymphadenitis: 44 (p < 0.01). The values of AG were statistically higher than those of SA (p = 0.0000). The ROC curve of these data determined the best cut-off levels for AA to be 30 (sensitivity: 0.43, specificity: 0.92, predictive value of a positive result: 0.87 and predictive value of a negative result: 0.58).
Conclusions:
1) The value of CRP in AA is higher than in other abdominal pain etiologies. Nevertheless, this value should not be used to deny surgery since it is often normal in SA. 2) When a CRP value > 40 mg/L is found in a suspected AA, one should think about GA and therefore, initiate prophylactic antibiotics and perform surgery immediately.