Abstract
Purpose
We aim to evaluate the diagnostic value and time course response of the triple inflammatory markers: white blood cell count (WBC), neutrophil percentage (Neu), and C-reactive protein (CRP) in pediatric acute appendicitis.
Methods
A retrospective review of clinical data pertaining to 1391 patients admitted with suspicion for pediatric appendicitis from 2012 to 2017 was conducted. Triple inflammatory markers were acquired upon admission. Appendicitis was confirmed histologically post-appendectomy. The diagnostic value and time course response of these markers was trended in relation to the duration of abdominal pain on admission.
Results
718 patients had histologically confirmed appendicitis. WBC and Neu demonstrate high sensitivity for early appendicitis at 94.6% and 80.0% at Day 1, while CRP demonstrates highest sensitivity of 97.9% at Day 4. The triple markers had poor overall diagnostic value when interpreted individually, however, had a high combined sensitivity of 99.7% and negative predictive value of 98.7% regardless of duration of disease. Overall negative appendectomy rate was 6.7% (n = 52). Among 19 patients with triple markers negative who underwent appendectomy, 17 (89.5%) were histologically normal.
Conclusions
The triple inflammatory markers have limited diagnostic value when interpreted individually, but are strong discriminators of pediatric appendicitis when combined. Their high sensitivity and negative predictive value could potentially help patients avoid unnecessary admissions or costly imaging studies, and reduce negative appendectomy rates. In addition, their objective nature confers an advantage over existing clinical scoring systems which comprise subjective elements.
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Study conception and design: Dr Angus, Dr Yap, Dr Nah, Dr Low, Dr Jacobsen, Ms Choo and Dr Chen. Data acquisition: Dr Angus, Dr Chiang, Dr Yap and Dr Chen. Analysis and data interpretation: Dr Angus, Dr Chiang, Dr Yap and Dr Chen. Drafting of the manuscript: Dr Chiang and Dr Chen. Critical revision: Dr Angus, Dr Chiang, Dr Yap, Dr Nah, Dr Low, Dr Jacobsen, Ms Choo and Dr Chen.
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This study was approved by centralized institutional review board in Singapore, SingHealth (CIRB number: 2016/2646). All procedures performed in studies were in accordance with the ethical standards of the institution.
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A waiver of informed consent was approved in accordance with the local ethical standards for non-interventional, retrospective study.
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Chiang, J.J.Y., Angus, M.I., Nah, S.A. et al. Time course response of inflammatory markers in pediatric appendicitis. Pediatr Surg Int 36, 493–500 (2020). https://doi.org/10.1007/s00383-020-04620-4
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DOI: https://doi.org/10.1007/s00383-020-04620-4