Predictive value of white blood cell count and C-reactive protein in children with appendicitis

doi:10.1016/j.jpedsurg.2007.02.010

Journal of Pediatric Surgery

Volume 42, Issue 7, July 2007, Pages 1208-1214

https://doi.org/10.1016/j.jpedsurg.2007.02.010 Get rights and content

Abstract

Background/Purpose

Few studies have addressed the predictive value of white blood cells (WBCs) and C-reactive protein (CRP) at different cutoff values in appendicitis. Our purpose was to determine the cutoff values for WBC and CRP at different periods during clinical evolution of appendicitis and to establish their use for the diagnosis of appendicitis and differentiation of simple from perforated appendicitis.

Methods

We studied 198 patients operated on for appendicitis, which were further divided into 4 subgroups according to the time from the onset of symptoms to diagnosis. Receiver operating characteristic curves were constructed for CRP and WBC; the best cutoff points were used to calculate the sensitivity and specificity to discriminate patients with and without appendicitis and patients with simple and perforated appendicitis.

Results

White blood cell and CRP individually and together had a high sensitivity to differentiate patients with and without appendicitis. The specificity of WBC and CRP taken individually and together to differentiate patients with simple and perforated appendicitis was high, but the sensitivity was low.

Conclusions

White blood cell and CRP could be used to support the clinical diagnosis of appendicitis, and, depending on the time from the onset of symptoms to diagnosis, to differentiate patients with and without appendicitis and discriminate simple from perforated appendicitis.

Section snippets

Patients and methods

From August 2004 to December 2005, we studied prospectively 198 consecutive pediatric patients (<15 years of age) who underwent appendectomies for suspected appendicitis at our institution. On admission, we recorded data including age, sex, time from the onset of symptoms to diagnostic (evolution), WBC counts, CRP levels, and after discharge from the hospital, the histological report of the resected appendix. The diagnosis was principally established on clinical grounds. In some patients, we

Results

Groups were comparable in terms of sex, age, and hours of evolution. White blood cell counts and CRP levels were significantly higher in patients with appendicitis (Table 1). Patients with normal appendix had similar demographical parameters, WBC counts, and CRP levels. Patients with appendicitis with more than 49 hours from the onset of symptoms to diagnosis were older than patients with less hours of evolution. White blood cell counts were higher for patients with more than 49 hours of

Discussion

The classic clinical picture of acute appendicitis has been widely known for more than 110 years [10]; however, it has been mostly described in adult patients. In addition, some atypical symptoms that could lead to errors in the diagnosis of appendicitis have also been described mainly in young adults and children [10], [11]. The problem with the erroneous diagnosis of appendicitis is that the removal of a normal appendix or on the contrary the delay in treatment of appendicitis associated to

Conclusions

White blood cell counts and CRP levels are reliable inflammatory markers that could be used to support the clinical diagnosis of appendicitis and, depending on the time from the onset of symptoms to diagnosis, could differentiate patients with and without appendicitis and discriminate simple appendicitis from perforated appendicitis in children.

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Which children could benefit from additional diagnostic tools in case of suspected appendicitis?

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Cited by (117)

Lack of Routine Postoperative Labs Not Associated With Complications in Pediatric Perforated Appendicitis
2024, Journal of Surgical Research
Postoperative (postop) management of pediatric perforated appendicitis varies significantly, and postop intra-abdominal abscesses (IAA) remain a significant issue. Between 2019 and 2020, our standardized protocol included routine postop labs after an appendectomy for perforated appendicitis. However, given the lack of predictive utility of these routine labs, we discontinued this practice in 2021. We hypothesize that discontinuing routine postop labs will not be associated with an increase in complication rates after an appendectomy for pediatric perforated appendicitis.
A single-institution, retrospective review of all pediatric appendectomies for perforated appendicitis from January 2019 to December 2021 was conducted at University Hospitals Rainbow Babies and Children's Hospital in Cleveland, Ohio. Data were collected on rate of complications (IAA development, re-admissions, bowel obstructions, superficial surgical site infections, intensive care unit transfers, Clostridium difficile infections, allergic reactions, and transfusions), postop imaging, postop interventions, and length of stay. Statistical analysis was completed using Fisher's exact test and Mann–Whitney U-test.
A total of 109 patients (2019-2020 n = 61, 2021 n = 48) were included in the study. All 61 patients from 2019 to 2020 had postop labs compared to only eight patients in 2021. There was no statistically significant difference between the two groups in overall complication rates, but there was a decrease in IAAs reported in 2021 (P = 0.03). There were no statistically significant differences in other complications, postop imaging usage, or postop interventions. The median length of stay was 4.5 d in 2021 compared to 6.0 d in 2019-2020 (P = 0.009).
Discontinuing routine postop labs is not associated with an increase in overall complications rates. Further studies are needed to determine whether routine postop labs can be safely removed in pediatric patients with perforated appendicitis, which would reduce patient discomfort and care costs.
Appendicitis in Children
2023, Advances in Pediatrics
Labs Do Not Predict Postoperative Intra-abdominal Abscess in Pediatric Perforated Appendicitis
2023, Journal of Surgical Research
We aim to evaluate the utility of postoperative labs in predicting the development of an intra-abdominal abscess (IAA) in pediatric patients with perforated appendicitis. We hypothesize that postoperative labs are not predictive of IAA development.
This was a single-institution retrospective cohort study that included pediatric patients (n = 61) who underwent surgery for perforated appendicitis from January 1, 2019 to December 1, 2020. Patients were stratified into those who developed a postoperative IAA (n = 22) and those who did not (n = 39). Postoperative labs (white blood cell [WBC] count, absolute neutrophil count, platelet count, C-reactive protein) were examined. Mann–Whitney U tests and chi-square tests were used to assess for differences between groups.
There was extensive heterogeneity and overlap in postoperative lab values between patients who developed an IAA and those who did not. Almost all patients who developed an IAA had clinical signs that were indicative of abscess formation regardless of their postoperative WBC count or change in WBC count. While patients who developed an IAA had a higher postoperative median WBC count (10.8 versus 8.4, P = 0.003) and a smaller WBC count decrease (−4.9 versus −7.4, P = 0.01), no cutoff value for any of the examined lab values specifically predicted abscess formation. Postoperative median absolute neutrophil count (7.4 versus 4.0, P = 0.15), platelet count (360 versus 353, P = 0.98), and C-reactive protein (8.20 versus 5.32, P = 0.06) did not differ significantly.
We conclude that postoperative labs have limited clinical utility in evaluating IAA development in children with perforated appendicitis.
Predictors and management outcomes of perforated appendicitis in sub-Saharan African countries: A retrospective cohort study
2022, Annals of Medicine and Surgery
Previous studies have found an association between various predictors and perforated appendicitis. However, there is limited evidence of studies determining the severity of acute appendicitis (AA) in resource-limited settings. Thus, this study aimed to identify predictors and outcomes of perforated appendicitis (PA) in sub-Saharan countries.
This is a retrospective cohort study of 298 adult patients who underwent surgical intervention for acute appendicitis. Demographic characteristics, clinical parameters, intraoperative findings, length of hospital stay, and postoperative complications were collected. We computed multivariate logistic regression to identify predictors of PA. P-value <0.05 was considered statistically significant.
Of 298 patients, PA was 142(47.65%). The identified risk factors for PA are referred patients (AOR = 3.932; 95% CI (2.201–7.027), fever >38 °C (AOR = 4.569; 95% CI (2.249–9.282), and duration of symptoms >2 days (AOR = 2.704; 95% CI (1.400–5.222). Perforation was associated with an increased rate of postoperative complications (45.07vs. 6.41%; P < 0.001) and a longer length of hospital stay (3 vs. 5 days; P < 0.001).
The incidences of PA in our study are consistent with other reports in developing countries. Referred patients, longer duration of symptoms >2 days, and presence of fever >38 °C were the best predictors of PA. The overall total postoperative complications and the length of hospital stays were higher in PA. Based on our findings, we recommend that the identified predictors should be considered during the preoperative diagnosis and subsequent management.
Inflammatory parameters as predictive factors for complicated appendicitis: A retrospective cohort study
2022, Annals of Medicine and Surgery
Acute appendicitis is a major cause of acute abdomen. Although its diagnosis is clinical, it is often supported by complementary diagnostic tests. Sometimes, delay in diagnosis can lead to worsening of the clinical picture, resulting in a complicated acute appendicitis. Some series have studied some clinical and analytical parameters as possible predictors of complicated acute appendicitis.
A retrospective analysis of patients admitted for acute appendicitis and undergoing appendectomy between January 2014 and December 2017 was performed in order to assess the possible existence of preoperative analytical predictive factors for complicated acute appendicitis (such as leukocytosis, C-reactive protein and ratio between neutrophils and lymphocytes).
841 patients underwent emergency appendectomy during the analysed period. This initial sample was divided into two groups: Group 1 with patients with uncomplicated acute appendicitis and Group 2 with patients with complicated acute appendicitis. Group 2's presentation age, duration of symptoms and hospital stay was significantly higher than Group 1. Regarding analytical parameters, the measurement of leukocytes, C-reactive protein and ratio between neutrophils and lymphocytes was significantly higher in patients with complicated acute appendicitis. After a multivariate analysis, it was found that only C-reactive protein was a good predictor of complicated acute appendicitis.
Several publications have studied and demonstrated the possible use of certain analytical parameters as predictors of complicated acute appendicitis. In our study, C-reactive protein proved to be a good independent predictor of complicated acute appendicitis and, therefore, when an assay of this protein exceeds 63.3 mg/L, faster surgical approach should be considered due to the high probability of the presence of a complicated picture of this clinical entity.
sTREM-1 as a diagnostic biomarker for acute appendicitis in children
2021, Asian Journal of Surgery
The typical history of acute appendicitis is observed in less than 60% of cases. Therefore, searching for a surrogate marker is mandatory. Our goal was to determine whether the soluble triggering receptor expressed on myeloid cells (sTREM-1) is an efficient biomarker for acute appendicitis.
sTREM-1 serum levels were measured in addition to carrying out routine diagnostic tests (urine dipstick, complete blood count and CRP) in children admitted to the Emergency Department with suspected appendicitis. Statistical analysis was performed in order to examine whether sTREM-1 was a significant predictor of appendicitis.
Fifty three of 134 children enrolled in the study were diagnosed with appendicitis. There was no significant difference in serum sTREM-1 levels (p = 0.111) between children with or without appendicitis (n = 81). Leukocytes, neutrophils and CRP were significantly elevated in the appendicitis group (p < 0.001). The appendix diameter was significantly larger and the Alvarado score significantly higher in the appendicitis group (p < 0.001).
serum sTREM-1 is not a good marker for acute appendicitis. Customary tests in addition to a proper patient history and physical examination are still the most effective methods to diagnose acute appendicitis.

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Original articlePredictive value of white blood cell count and C-reactive protein in children with appendicitis

Abstract

Background/Purpose

Methods

Results

Conclusions

Section snippets

Patients and methods

Results

Discussion

Conclusions

J Pediatr Surg

Surgery

Ann Emerg Med

Ann Emerg Med

Am J Emerg Med

Ann Emerg Med

J Pediatr Surg

J Pediatr Surg

J Gastrointest Surg

Am J Emerg Med

Which children could benefit from additional diagnostic tools in case of suspected appendicitis?

J Pediatr Surg

Original article
Predictive value of white blood cell count and C-reactive protein in children with appendicitis