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Predictive value of CRP in children with appendicitis

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Predictive value of CRP in children with appendicitis

Postby Dr.Osama » Sun Apr 28, 2013 3:03 am

Predictive value of C-reactive protein in children with appendicitis
Apr 2013
Marcelo A Beltran
Few studies have addressed the predictive value of C-reactive protein at different cutoff values in appendicitis. We have determined the cutoff values for C-reactive protein levels at different periods during clinical evolution of appendicitis and established their use to support the diagnosis of appendicitis. The analysis of C-reactive protein levels demonstrated a high sensitivity to differentiate patients with and without appendicitis. C-reactive protein levels can be used to support the clinical diagnosis of appendicitis, and depending on time from onset of symptoms to diagnosis, they also can be used to differentiate patients with and without appendicitis. The determination of C-reactive protein levels in patients with suspected appendicitis will help to diagnose appendicitis earlier, avoiding perforation and consequently avoiding the economic and legal consequences associated with complications of appendicitis.

The classic clinical picture of appendicitis has been widely known for more than 110 years [1], and described mainly in adults. Some atypical symptoms that could lead to errors in the diagnosis of appendicitis have also been described in young adults and children [1,2]. The problem with an erroneous diagnosis of appendicitis is that the removal of a normal appendix or, on the contrary, the delay in treatment of appendicitis associated to its major complications, such as phlegmon, abscess or peritonitis, has ethical, economical and legal implications [3,4]. To avoid these problems and to improve the early and accurate diagnosis of appendicitis, technological approaches to diagnose appendicitis have been developed, including ultrasound, computed tomographic scan with intravenous contrast or immunological markers, magnetic resonance imaging, radiological contrasted techniques, and many different laboratory tests including C-reactive protein (CRP) [4-8]. The role of CRP levels in patients with appendicitis has been extensively studied in adults [9-14]. Some studies have addressed the predictive value of CRP at different cutoff levels in adults determined by ROC curve analysis and have found that CRP levels were useful for the diagnosis of appendicitis during the first 3 days after the onset of symptoms [14].

Appendicitis is the most common cause of abdominal surgery in children. Perforation rates as high as 50 % at the initial visit have been reported due to delays in diagnosis and late visits to the emergency department [15-17]. White blood cell (WBC) counts and CRP levels are commonly obtained in children with suspected appendicitis [1,2]. White blood cell counts have been found to be insensitive and unspecific to diagnose appendicitis [2-4] and so has CRP. However, some studies suggest that CRP may be more sensitive than WBC in detecting appendiceal perforation [8,9,17]. Few studies, mostly including only adult patients, have addressed the predictive value of CRP at different cutoff values in patients with appendicitis [14-16].

Some authors have attempted to determine the cutoff values for CRP levels at different periods from the time of the onset of symptoms to diagnosis in patients with histologically proven appendicitis [7,8]; however, these and other similar studies have been performed in adult patients. A recent retrospective report [9] analyzed the use of CRP levels in children with simple appendicitis (less than 48 hours of evolution) and children with advanced appendicitis (more than 48 hours of evolution) and concluded that a rise in CRP levels after 48 hours from the onset of symptoms was a strong indicator of appendiceal perforation.

We have determined cutoff values for CRP in children presenting at the hospital in different time slots after the onset of symptoms and we have established the sensitivity and specificity of CRP for the diagnosis of appendicitis in this population.

CONCLUSIONS
CRP levels can be used to support the clinical diagnosis of appendicitis, and depending on time from onset of symptoms to diagnosis, CRP levels can also be used to differentiate patients with and without appendicitis. The determination of CRP levels in patients with suspected appendicitis will help to diagnose appendicitis earlier, avoiding perforation and consequently avoiding the economic and legal consequences associated with complications of appendicitis
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Re: Predictive value of CRP in children with appendicitis

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Re: Predictive value of CRP in children with appendicitis

Postby lensmall002 » Mon Jul 24, 2017 7:10 pm

The classic clinical picture of appendicitis has been widely known for more than 110 years [1], and described mainly in adults. Some atypical symptoms that could lead to errors in the diagnosis of appendicitis have also been described in young adults and children [1,2]. The problem with an erroneous diagnosis of appendicitis is that the removal of a normal appendix or, on the contrary, the delay in treatment of appendicitis associated to its major complications, such as phlegmon, abscess or peritonitis, has ethical, economical and legal implications [3,4]. To avoid these problems and to improve the early and accurate diagnosis of appendicitis, technological approaches to diagnose appendicitis have been developed, including ultrasound, computed tomographic scan with intravenous contrast or immunological markers, magnetic resonance imaging, radiological contrasted techniques, and many different laboratory tests including C-reactive protein (CRP) [4-8]. The role of CRP levels in patients with appendicitis has been extensively studied in adults [9-14]. Some studies have addressed the predictive value of CRP at different cutoff levels in adults determined by ROC curve analysis and have found that CRP levels were useful for the diagnosis of appendicitis during the first 3 days after the onset of symptoms [14].


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Re: Predictive value of CRP in children with appendicitis

Postby ninest123 » Fri Sep 08, 2017 11:10 am

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Re: Predictive value of CRP in children with appendicitis

Postby azxs02 » Thu Sep 21, 2017 4:57 am

Can be used to support clinical diagnosis.












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Re: Predictive value of CRP in children with appendicitis

Postby azxs02 » Thu Sep 21, 2017 4:57 am

Can be used to support clinical diagnosis.












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Re: Predictive value of CRP in children with appendicitis

Postby tonkp » Thu Sep 28, 2017 10:42 am

Very interesting information.







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