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

Comparative Study of Acute and Perforated Appendicitis

“…Most studies in literature defined their perforated appendicitis group based on surgical reports. Fewer studies defined this group based on the histology report [10,13] and some combined the surgical report with the histology report [11]. Based on the literature and the ICD10 we chose to use the surgical report.…”

“…The perforated appendicitis group consisted of patients whose surgical report noticed a perforated appendix, abscess formation or purulent peritoneal fluid. There is controversy in literature on how to define a perforated appendicitis, which might either be based on the surgical report [2,4,7,9,14] or the histology report [10,13]. A second rationale for using the surgeon's findings as gold standard is that after-treatment is based upon the surgeon's opinion.…”

“…In children CRP values aid in the diagnosis of perforated appendicitis. Whether LC may discriminate simple from perforated appendicitis in the pediatric population remains uncertain [9][10][11][12][13]. Despite previous investigations it remains unclear whether LC, CRP levels and Erythrocyte Sedimentation Rate (ESR) levels combined with body temperature and duration of abdominal pain have a predictive value in diagnosing a perforated appendicitis in unselected patient groups.…”

Missed Appendicitis in Primary Care: Lessons Learned

“…The presence or absence of inflammatory markers is either support or refute diagnosis of acute appendicitis such as, increase level of leucocyte/neutrophil/granulocyte and C-reactive protein (CRP) [12][13][14][15]. Urine analysis and microscopy can either support or refute urinary tract infection, but it is confusing in pelvic acute appendicitis [16].…”

“…Misdiagnosis rate was ranging from 7.5% to 37% for children [45] and the reason of misdiagnosis was either acute gastritis or gastroenteritis [46]. The common age incidence of childhood appendicitis is mostly at 9-12 years [47], and the red flag of acute appendicitis in childhood are vomiting [48], leukocytosis, high C-reactive protein level [49] right lower quadrant tenderness [50,51]. A high level of clinical suspicion; may need further investigation by either, abdominal ultra-sonographers (sensitivities range from 85% -90% and specificities range from 95% -100%) and CT scan which increase diagnostic accuracy and decrease negative laparotomy [51].…”