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Can common serum biomarkers predict complicated appendicitis in children?

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Abstract

Purpose

As appendicitis in children can be managed differently according to the severity of the disease, we investigated whether commonly used serum biomarkers on admission could distinguish between simple and complicated appendicitis.

Methods

Admission white blood cell (WBC), neutrophil (NEU), and C-reactive protein (CRP) levels were analysed by ROC curve, and Kruskal–Wallis and contingency tests. Patients were divided according to age and histology [normal appendix (NA), simple appendicitis (SA), complicated appendicitis (CA)].

Results

Of 1197 children (NA = 186, SA = 685, CA = 326), 7% were <5 years, 55% 5–12, 38% 13–17. CA patients had higher CRP and WBC levels than NA and SA (p < 0.0001). NEU levels were lower in NA compared to SA or CA (p < 0.0001), but were similar between SA and CA (p = 0.6). CA patients had higher CRP and WBC levels than SA patients in 5–12- (p < 0.0001) and 13–17-year groups (p = 0.0075, p = 0.005), but not in <5-year group (p = 0.72, p = 0.81). We found CRP >40 mg/L in 58% CA and 37% SA (p < 0.0001), and WBC >15 × 109/L in 58% CA and 43% SA (p < 0.0001).

Conclusions

Admission CRP and WBC levels may help the clinician predict complicated appendicitis in children older than 5 years of age. Early distinction of appendicitis severity using these tests may guide caregivers in the preoperative decision-making process.

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Acknowledgements

We would like to thank all our surgical colleagues in our respective departments who contributed patients to this data set. Without their involvement, this study would not have been possible.

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Authors and Affiliations

  1. Division of General and Thoracic Surgery, The Hospital for Sick Children, 1524C-555 University Ave, Toronto, ON, M5G 1X8, Canada

    Augusto Zani

  2. Paediatric Surgery, Royal Children’s Hospital, Melbourne, Australia

    Warwick J. Teague

  3. Paediatric Surgery, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK

    Simon A. Clarke & Munther J. Haddad

  4. Paediatric Surgery, Adelaide Women’s and Children’s Hospital, Adelaide, Australia

    Sanjeev Khurana

  5. Paediatric Surgery, Norfolk and Norwich University Hospital, Norwich, UK

    Thomas Tsang

  6. Paediatric Surgery, Monash Children’s Hospital, Melbourne, Australia

    Ramesh M. Nataraja

  7. Department of Paediatrics, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia

    Ramesh M. Nataraja

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  1. Augusto Zani
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Correspondence to Augusto Zani.

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Zani, A., Teague, W.J., Clarke, S.A. et al. Can common serum biomarkers predict complicated appendicitis in children?. Pediatr Surg Int 33, 799–805 (2017). https://doi.org/10.1007/s00383-017-4088-1

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