Diagnosing pediatric appendicitis: usefulness of laboratory markers

• Published in: The American journal of emergency medicine Vol. 28; no. 9; pp. 1009 - 1015
• Main Authors: Kwan, Karen Y., Nager, Alan L.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.11.2010; Elsevier; Elsevier Limited
• Subjects: Abdominal Pain - diagnosis; Adolescent; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Appendicitis; Appendicitis - blood; Appendicitis - diagnosis; Bacterial infections; Biological and medical sciences; Biomarkers - blood; C-Reactive Protein - analysis; Calcitonin - blood; Calcitonin Gene-Related Peptide; Child; Child, Preschool; Confidence Intervals; Diagnosis, Differential; Emergency; Emergency and intensive care: neonates and children. Prematurity. Sudden death; Emergency medical care; Female; Histopathology; Humans; Infant; Intensive care medicine; Lactic Acid - blood; Leukocyte Count; Logistic Models; Male; Medical sciences; Observational studies; Odds Ratio; Pain; Pediatrics; Prospective Studies; Protein Precursors - blood; Regression analysis; Risk Factors; ROC Curve; Studies; Human; Pediatrics; Intensive care; Appendicitis; Digestive diseases; Intestinal disease; Child; Resuscitation
• ISSN: 0735-6757; 1532-8171; 1532-8171
• DOI: 10.1016/j.ajem.2009.06.004

This study aimed to evaluate the utility of C-reactive protein (CRP), procalcitonin (PCT), d-lactate, and white blood cell (WBC) count as an aid to distinguish appendicitis from other diagnoses. This prospective, observational study was conducted at an urban tertiary academic pediatric emergency department (ED). Subjects aged 1 to 18 years presenting with abdominal pain suspicious for acute appendicitis were enrolled. Data included history, physical examination, laboratory data (complete blood count, CRP, d-lactate, PCT [semiquantitative]), laboratory results, x-rays, surgical consultation notes, histopathology, and admission data. Stepwise logistic regression analysis was performed to identify independent risk factors. Two hundred nine subjects (59% male, 41% female) were enrolled over 6 months. One hundred fifteen subjects were histologically diagnosed with appendicitis; 94 subjects did not have appendicitis and were used as controls. Mean values of WBC, CRP, PCT, and absolute neutrophil count in subjects with definitive appendicitis were significantly higher than in subjects with no definitive appendicitis. d-Lactate levels were noncorrelative. Significant independent risk factors identified for definitive appendicitis included WBC count more than 12 cells × 1000/mm 3 (adjusted odds ratio [AOR], 6.54), CRP level greater than 3 mg/dL (AOR, 3.44), presence of hopping pain (AOR, 2.69), and presence of pain with walking (AOR, 2.56). Odds ratio for definitive appendicitis and its 95% confidence interval was found to be 7.75 for subjects with both WBC more than 12 cells × 1000/mm 3 and CRP greater than 3 mg/dL. C-reactive protein with WBC is useful in distinguishing appendicitis from other diagnoses in pediatric subjects presenting to the ED. White blood cell count greater than >12 cells × 1000/mm 3 and CRP greater than 3 mg/dL increases the likelihood of appendicitis. d-Lactate is not a useful laboratory adjunct.