C-Reactive Protein and Procalcitonin Are Predictors of the Severity of Acute Appendicitis in Children

Gavela, Teresa; Cabeza, Beatriz; Serrano, Ana; Casado‐Flores, Juan

doi:10.1097/pec.0b013e318252d875

Cited by 46 publications

(27 citation statements)

References 12 publications

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“…3 Current strategies for diagnosing appendicitis include the use of clinical scoring systems, 4-7 laboratory markers of infection and inflammation, [8][9][10] and…”

Section: Introductionmentioning

confidence: 99%

Variation in the Diagnosis and Management of Appendicitis at Canadian Pediatric Hospitals

et al. 2015

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Objectives: The objective was to characterize the variations in practice in the diagnosis and management of children admitted to hospitals from Canadian pediatric emergency departments (EDs) with suspected appendicitis, specifically the timing of surgical intervention, ED investigations, and management strategies.Methods: Twelve sites participated in this retrospective health record review. Children aged 3 to 17 years admitted to the hospital with suspected appendicitis were eligible. Site-specific demographics, investigations, and interventions performed were recorded and compared. Factors associated with afterhours surgery were determined using generalized estimating equations logistic regression.Results: Of the 619 children meeting eligibility criteria, surgical intervention was performed in 547 (88%). After-hours surgery occurred in 76 of the 547 children, with significant variation across sites (13.9%, 95% confidence interval = 7.1% to 21.6%, p < 0.001). The overall perforation rate was 17.4% (95 of 547), and the negative appendectomy rate was 6.8% (37 of 547), varying across sites (p = 0.004 and p = 0.036, respectively). Use of inflammatory markers (p < 0.001), blood cultures (p < 0.001), ultrasound (p = 0.001), and computed tomography (p = 0.001) also varied by site. ED administration of narcotic analgesia and antibiotics varied across sites (p < 0.001 and p = 0.001, respectively), as did the type of surgical approach (p < 0.001). After-hours triage had a significant inverse association with after-hours surgery (p = 0.014).Conclusions: Across Canadian pediatric EDs, there exists significant variation in the diagnosis and management of children with suspected appendicitis. These results indicate that the best diagnostic and management strategies remain unclear and support the need for future prospective, multicenter studies to identify strategies associated with optimal patient outcomes.ACADEMIC EMERGENCY MEDICINE 2015;22:811-822 © 2015 by the Society for Academic Emergency Medicine A ppendicitis is the most common nontraumatic surgical emergency in children, 1,2 yet it continues to present diagnostic and management uncertainty.3 Current strategies for diagnosing appendicitis include the use of clinical scoring systems, 4-7 laboratory markers of infection and inflammation, [8][9][10] and

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“…3 Current strategies for diagnosing appendicitis include the use of clinical scoring systems, 4-7 laboratory markers of infection and inflammation, [8][9][10] and…”

Section: Introductionmentioning

confidence: 99%

Variation in the Diagnosis and Management of Appendicitis at Canadian Pediatric Hospitals

et al. 2015

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“…Because the specimen tissue may become damaged while delivered through the trocar port incision in laparoscopic appendectomy, the pathologic analysis may be influenced by damaged tissue, bearing inaccuracy. However, as evidenced by previous studies indicating that the CRP level directly correlates with the severity of the inflammation in acute appendicitis [8,9], increased symptom duration was found to correlate with the aggravation of the disease. This finding also supports the notion that increased symptom duration is correlated with increased medical cost and length of hospital stay.…”

Section: Discussionmentioning

confidence: 75%

Evaluating the efficacy of the current diagnosis-related group reimbursement system for laparoscopic appendectomy at a single institute in Korea

2014

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PurposeThe diagnosis-related group (DRG) system has been adapted to reduce overall medical costs by grouping and classifying relatively homogenous patients based on similar resource consumption patterns in the treatment. However, despite its wide range of disease manifestation from early inflammation to severe peritonitis, acute appendicitis is included in the DRG system. Responding to a need to assess the DRG system for patients diagnosed with appendicitis, this study evaluates the efficacy of the current DRG system applied to a broad spectrum of the patients with appendicitis undergoing laparoscopic appendectomy.MethodsA retrospective review was conducted of the patients who underwent laparoscopic appendectomy. Based on the DRG codes' classification, the patients were analyzed for the amount of DRG reimbursement and the total in-patient cost in relation to the time sequence of the disease onset. Statistical analysis was performed to find factors correlated with the DRG reimbursement and total in-patient cost.ResultsFindings indicate that, as the symptom duration becomes prolonged, the CRP level and the use of peritoneal drainage increased. Patients with a symptom duration greater than 24 hours required approximately 5 days of hospital stay, 0.5 day longer in the length of hospital stay than that of patients with less than 12 hours of the onset time. As expected, the amount of DRG reimbursement and the total in-patient cost accumulated as the symptom duration increased.ConclusionThe current DRG reimbursement system for the patients undergoing laparoscopic appendectomy recompenses a broad spectrum of patients diagnosed with appendicitis effectively.

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“…The patients were divided into two groups according to their anatomopathological findings. 5,15 The first group (group 1) comprised patients with uncomplicated appendicitis (an intact appendiceal mucosa with mild-to-moderate infiltration of inflammatory cells), and the second group (group 2) included patients with complicated appendicitis (perforated or gangrenous appendicitis).…”

Section: Study Participantsmentioning

confidence: 99%

“…There are studies on both children and adults that connect serum CRP levels with the severity of appendicitis, making the measurement of this protein a potential tool for the detection of complications. 5,6 CRP is also considered as a marker of low-grade chronic inflammation in light of findings from studies carried out in recent years connecting CRP levels with body mass index. [7][8][9] In addition, CRP has been employed as a cardiovascular risk marker.…”

Section: Introductionmentioning

confidence: 99%

C-reactive protein expression in adipose tissue of children with acute appendicitis

et al. 2018

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C-Reactive Protein and Procalcitonin Are Predictors of the Severity of Acute Appendicitis in Children

Abstract: On admission, CRP and PCT predict the outcome of pediatric patients with appendicitis. Children with CRP greater than 3 mg/dL and/or PCT greater than 0.18 ng/mL have a greater risk of complications; thus, intervention should be early, and patients should be monitored closely.

Cited by 46 publications

References 12 publications

Variation in the Diagnosis and Management of Appendicitis at Canadian Pediatric Hospitals

Variation in the Diagnosis and Management of Appendicitis at Canadian Pediatric Hospitals

Evaluating the efficacy of the current diagnosis-related group reimbursement system for laparoscopic appendectomy at a single institute in Korea

C-reactive protein expression in adipose tissue of children with acute appendicitis

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