Laboratory Tests in Addition to the Alvarado Score in the Management of Acute Appendicitis in School-Age Children

Abstract

The aim of the study was to determine whether the Alvarado score (AS) together with laboratory tests could be used to distinguish patients with acute appendicitis (AA) from acute mesenteric lymphadenitis (AML). Fifty-seven patients (7–18 years) with suspected AA were included in the prospective study (October 2010 – October 2013). Thirty-one patients underwent surgery for AA and 26 were not treated surgically and were diagnosed AML on ultrasonography. AS, white blood cell count (WBC), C – reactive protein (CRP) and serum cytokines (EGF, IL-10, IL-12(p70), IL-1β, IL-4, IL-6, IL-8, IL-17, MCP-1, TNF-α) were obtained on admission and were compared between groups. Mean age of the 57 patients was 12.9 (SD 3.2). Accuracy (AR) for AS ≥ 7 alone was 73.7% for AA. Modified AS with certain serum cytokines seemed to be a reliable tool for initial differential diagnosis between AA and AML in school-age children. Based on these results, AS ≥ 7, WBC ≥ 10.7 × 103/µL and serum IL-6 ≥ 4.3 pg/mL assessed altogether will yield more sensitivity for AA. Also for further advanced diagnostics, we propose to take into account the serum IL-6, IL-8, MCP-1, CRP cut-off levels in the differential diagnosis between complicated and uncomplicated AA to decide whether the treatment should be conservative or surgical.

Case Series of Variable Acute Appendicitis in Children with SARS-CoV-2 Infection

“…He et al performed autopsies on patients who died of SARS, and the pathological results showed that in ACE2-expressing cells, monocyte chemokine-1 (MCP-1), tumour growth factor-β1 (TGF-β1), tumour necrosis factor-α (TNF-α), interleukin (IL)-1β and IL-6, were highly expressed [ 21 ]. Referencing our previous study, serum MCP-1 and IL-6 were significantly increased in children with acute complicated appendicitis [ 22 ]. This also could explain the appendiceal rupture within 24 h of disease onset for Patient Nos.…”

Surgical and non-surgical treatment of paediatric appendicitis: can algorithms help us to predict perforation?

“…The clinical and laboratory criteria served as thresholds for a patient's inclusion into one of the groups (internal hospital document REK-052/01 from 2017). The criteria were based on the previous studies (Zviedre et al, 2019;Taurina et al, 2020).…”

“…During the study period of 2014 to 2015, the Alvarado score alone was used to separate AnA and AcA cases, but the results showed that the diagnosis and treatment should be im- proved and standardised. It was decided to create a diagnostic and treatment algorithm for use in the ED as well as in the paediatric surgery clinic (Zviedre et al. 2019).…”

“…A prospective study was performed. A total of 178 patients aged 7 to 18 years with suspicion of AA at CCUH were included in the period from 2010 to 2013 (Zviedre et al, 2019). In 2016, an initial version of an AA diagnostic and treatment algorithm was created and accepted by the hospital administration for practical use for patients with suspicion of AA and confirmed diagnosis of AA.…”

“…In 2016, an initial version of an AA diagnostic and treatment algorithm was created and accepted by the hospital administration for practical use for patients with suspicion of AA and confirmed diagnosis of AA. Clinical symptoms, Alvarado score (Alvarado, 1986), laboratory and radiological findings were included in the algorithm (Zviedre et al, 2019). The first evaluation of the algorithm was done by a performing a retrospective study of patients suspected for AnA in CCUH in 2017 (Taurina et al, 2020).…”