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Time course response of inflammatory markers in pediatric appendicitis

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Abstract

Purpose

We aim to evaluate the diagnostic value and time course response of the triple inflammatory markers: white blood cell count (WBC), neutrophil percentage (Neu), and C-reactive protein (CRP) in pediatric acute appendicitis.

Methods

A retrospective review of clinical data pertaining to 1391 patients admitted with suspicion for pediatric appendicitis from 2012 to 2017 was conducted. Triple inflammatory markers were acquired upon admission. Appendicitis was confirmed histologically post-appendectomy. The diagnostic value and time course response of these markers was trended in relation to the duration of abdominal pain on admission.

Results

718 patients had histologically confirmed appendicitis. WBC and Neu demonstrate high sensitivity for early appendicitis at 94.6% and 80.0% at Day 1, while CRP demonstrates highest sensitivity of 97.9% at Day 4. The triple markers had poor overall diagnostic value when interpreted individually, however, had a high combined sensitivity of 99.7% and negative predictive value of 98.7% regardless of duration of disease. Overall negative appendectomy rate was 6.7% (n = 52). Among 19 patients with triple markers negative who underwent appendectomy, 17 (89.5%) were histologically normal.

Conclusions

The triple inflammatory markers have limited diagnostic value when interpreted individually, but are strong discriminators of pediatric appendicitis when combined. Their high sensitivity and negative predictive value could potentially help patients avoid unnecessary admissions or costly imaging studies, and reduce negative appendectomy rates. In addition, their objective nature confers an advantage over existing clinical scoring systems which comprise subjective elements.

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Author notes

  1. Jayne J. Y. Chiang and Mark Ian Angus contributed equally to this work.

Authors and Affiliations

  1. Department of Pediatric Surgery, KK Women’s and Children’s Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore

    Jayne J. Y. Chiang, Mark Ian Angus, Shireen A. Nah, Anette S. Jacobsen, Yee Low, Candy S. C. Choo, Te-Lu Yap & Yong Chen

  2. Division of Surgery, Duke-NUS Medical School, Singapore, Singapore

    Shireen A. Nah, Anette S. Jacobsen, Yee Low & Yong Chen

  3. Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore

    Anette S. Jacobsen, Yee Low & Te-Lu Yap

Authors
  1. Jayne J. Y. Chiang
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  2. Mark Ian Angus
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  3. Shireen A. Nah
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  4. Anette S. Jacobsen
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  5. Yee Low
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  6. Candy S. C. Choo
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  7. Te-Lu Yap
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  8. Yong Chen
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Contributions

Study conception and design: Dr Angus, Dr Yap, Dr Nah, Dr Low, Dr Jacobsen, Ms Choo and Dr Chen. Data acquisition: Dr Angus, Dr Chiang, Dr Yap and Dr Chen. Analysis and data interpretation: Dr Angus, Dr Chiang, Dr Yap and Dr Chen. Drafting of the manuscript: Dr Chiang and Dr Chen. Critical revision: Dr Angus, Dr Chiang, Dr Yap, Dr Nah, Dr Low, Dr Jacobsen, Ms Choo and Dr Chen.

Corresponding authors

Correspondence to Te-Lu Yap or Yong Chen.

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Conflict of interest

The authors have no conflict of interest to disclose.

Ethical approval

This study was approved by centralized institutional review board in Singapore, SingHealth (CIRB number: 2016/2646). All procedures performed in studies were in accordance with the ethical standards of the institution.

Informed consent

A waiver of informed consent was approved in accordance with the local ethical standards for non-interventional, retrospective study.

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Chiang, J.J.Y., Angus, M.I., Nah, S.A. et al. Time course response of inflammatory markers in pediatric appendicitis. Pediatr Surg Int 36, 493–500 (2020). https://doi.org/10.1007/s00383-020-04620-4

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  • DOI: https://doi.org/10.1007/s00383-020-04620-4

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