Can ruptured appendicitis be detected preoperatively in the ED?

A scoring system to predict the severity of appendicitis in children

“…Both clinical, laboratory, and radiological variables have been reported to be of value in diagnosing complex appendicitis, but the results are equivocal [12e17,22e29]. In children, complex appendicitis is seen more often in younger children, whereas in adults, it is seen more often in patients >50-y-old, confirming the general idea that complex appendicitis occurs in the extreme ages [16,24,26]. Even though clinical variables 521 522 523 524 525 526 527 528 529 530 531 532 533 534 535 536 537 538 539 540 541 542 543 544 545 546 547 548 549 550 551 552 553 554 555 556 557 558 559 560 561 562 563 564 565 566 567 568 569 570 571 572 573 574 575 576 577 578 579 580 581 582 583 584 585 586 587 588 589 590 591 592 593 594 such as duration of abdominal pain were integrated in previous models as well as in ours, we need to keep in mind that these variables are of subjective nature and their reproducibility is low [13,16].…”

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

“…Overall, DA was high (80%) at 12, 48, and more than 49 hours, decreasing to 70% at 24 hours. We, as well as others, believe that the diagnosis of appendicitis and its complications remains clinical [10,11,[13][14][15][16][17][20][21][22]; WBC counts and CRP levels are unspecific systemic inflammatory markers, and their importance and context of their use must support the clinical diagnosis of appendicitis.…”

Is hyperbilirubinaemia in appendicitis a better predictor of perforation than C-reactive protein? — a prospective study

“…Length of hospital stay is directly related to postoperative complications which present with a higher frequency in perforated appendicitis [7,9,17,18]. The length of hospital stay has decreased, and currently patients with non-perforated appendicitis have a median hospital stay of 2 days [3], and patients with perforated appendicitis a median of 7.5 ± 3 days [1,3].…”

“…However, we as well as others believe that the diagnosis of appendicitis is clinical [12][13][14][15][16]. The most commonly laboratory tests used to support the diagnosis of appendicitis are white blood cell count (WBC) and C-reactive protein (CRP) [11,17,18], these markers have been studied together with other parameters in an effort to improve and predict the preoperative diagnosis of perforated appendicitis, nonetheless only an elevated CRP, a prolonged period of symptom's evolution, and fever have been identifi ed as useful markers of perforation [17,18]. Recently, it has been proposed that an elevated total bilirubin (TB) level could be used as a specifi c marker for the prediction of perforated appendicitis [19,20].…”