Abstract
Objective. To assess the predictive value of procalcitonin in detecting acute appendicitis (AP) in children, and to determine a cutoff value of procalcitonin which can safely include/exclude the diagnosis of acute appendicitis in children with acute abdominal pain. Methods. Prospective cohort study of children aged 5–17 years presenting to the emergency room with right lower quadrant (RLQ) tenderness and strong suspicion for acute AP. In addition to standard diagnostic workup for acute AP, a quantitative procalcitonin level was measured using immunoluminometric assay. Recursive partitioning model was used to assess the usefulness of procalcitonin in the diagnosis of appendicitis. Results. Of the 50 children studied, 48% were diagnosed to have AP. The mean procalcitonin level was higher among the children with appendicitis (P = 0.3). Using the recursive partitioning model, we identified a cutoff value of procalcitonin level of 0.39 with a likelihood ratio presence of appendicitis 3.25 and absence of appendicitis 0.8. None of the study subjects with procalcitonin level <0.39 and WBC count of <6.76 K had appendicitis. Conclusions. In conjunction with the clinical symptoms, a procalcitonin level and WBC count could be a strong predictor of acute appendicitis in children.
Highlights
Abdominal pain is one of the most frequently encountered complaints in the pediatric emergency room (ER)
Prospective cohort study of children aged 5–17 years presenting to the emergency room with right lower quadrant (RLQ) tenderness and strong suspicion for acute AP
A convenience sample of children ages 5–17 years presenting to the Pediatric Emergency Department (PED) for evaluation of right lower quadrant abdominal pain without signs of obvious gastroenteritis, no recent diagnosis or workup for appendicitis, no chronic hematologic, immunologic or gastrointestinal disease, and nonpregnant were enrolled for the study
Summary
Abdominal pain is one of the most frequently encountered complaints in the pediatric emergency room (ER). The approach to a child with abdominal pain often presents a dilemma to the pediatric ER staff. The pediatric ER physician and surgeon must be able to develop a differential diagnosis based on the clinical presentation of the child, in order to formulate a final diagnosis. Amongst the numerous etiologies of abdominal pain in children, acute appendicitis is one of the most common one that requires immediate intervention. Appendicitis affects 6% of the population [1, 2]. Morbidity and mortality rates are related to the time from the first onset of symptoms to the definitive diagnosis. Complications of misdiagnosing appendicitis include intraabdominal abscess, wound infection, adhesion formation, bowel obstruction, and infertility
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