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Year : 2011  |  Volume : 8  |  Issue : 3  |  Page : 309-312

Appendicitis in paediatric age group: Correlation between preoperative inflammatory markers and postoperative histological diagnosis

1 Department of Surgery, Specialist Registrar in General Surgery, Aintree University Hospital, Liverpool, United Kingdom
2 Department of Surgery, Associate Specialist in General Surgery, Prince Charles Hospital, Merthyr Tydfil, United Kingdom
3 Department of Surgery, CT2 doctor in General Surgery, Pilgrim Hospital, Boston, Lincolnshire, United Kingdom
4 Department of Surgery, Consultant General Surgeon and Lead Paediatric Surgeon, Prince Charles Hospital, Merthyr Tydfil, United Kingdom

Correspondence Address:
Peter Mekhail
Specialist Registrar in General Surgery, 2 Maes Yr Efail, Llangennech, Llanelli, SA14 8WD
United Kingdom
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0189-6725.91676

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Introduction: Clinical diagnosis of appendicitis can be challenging, particularly in the paediatric age group. There is an increased risk of perforation in paediatrics; therefore, a need for sensitive and specific diagnostic tool is mandatory. Aim: The aim of this study is to evaluate the role of preoperative inflammatory markers in supporting the clinical diagnosis of appendicitis in the paediatric age group. Materials and Methods: Retrospective study of 268 emergency paediatric appendicectomies performed in a District General Hospital in Wales, over a period of seven years (2002-2009). The data collected from hospital database include preoperative inflammatory markers, C-reactive protein (CRP) and white blood cells count (WBCC) and post-operative histology. Statistical analysis was performed using Fisher's exact test. Results: The median age group in the study was 12 (2-16). 141 (53%) patients were <12 years, while 127 (47%) patients were 12-16 years old. Male : female ratio = 1 : 1 (134 each). Inflammatory markers were not done for 94 patients (35%). CRP was done for 149 cases (55.6%), while WBCC was done for 172 cases (64%). Both markers were done together for 147 cases (54.8%). Histology was positive (inflamed / gangrenous appendix) in 202 cases (75.4%). Eight cases were associated with Enterobious vermicularis infestation and one patient had carcinoid tumour. The sensitivity and specificity of CRP were 82% and 60%, respectively, with positive predictive value (PPV) of 87% (P<0.0001), while those of WBCC were 80% and 59%, respectively, with PPV of 88% (P<0.0001). The sensitivity and specificity of both markers together were 80% and 70%, respectively, with PPV= 81% (P = 3.11E-8). 94 patients (35%) had an appendicectomy operation based on clinical diagnosis alone without preoperative inflammatory markers having been tested. In 28 cases (30%) out of these, postoperative histology revealed normal appendix (P = 0.18). Conclusion: CRP and WBCC are simple tests that can provide a significant role supporting the clinical diagnosis of acute appendicitis in the paediatric age group.

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