Diagnostic value of inflammatory markers (complete blood count, erythrocyte sedimentation rate, and C-reactive protein) in children with acute appendicitis

Abstract

Objective The aim of the study was to evaluate the diagnostic value of inflammatory markers [complete blood cell count (CBC), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP)] for the differentiation of acute appendicitis from nonspecific abdominal pain in children.
Patients and methods In this prospective study, 150 children admitted for referral to Mohammad Kermanshahi Hospital (Kermanshah, Iran) (from June 2011 to May 2012), and suspected to have acute appendicitis were enrolled. Careful assessment of history and observation of physical signs were performed and evaluated during the hospitalization period; decisions to operate or to observe were made on the basis of clinical characteristics. Patients who had acute appendicitis, according to the pathologic report, were included in the study group and patients who had nonspecific abdominal pain were included in the control group. Venous blood samples were taken from all patients on admission and sent to the laboratory and CBC, ESR, and CRP levels were measured. Serum CRP level more than 8 lg/ml, ESR more than 20 mm/h, and white blood cell (WBC) count more than 10 000/mm3 were considered abnormal. Sensitivity, specificity, positive predictive, and negative predictive values were calculated for each test and in combination.
Results In total, 150 patients were studied in two groups; 54% were females and 46% were males. The mean age of the patients was 7.7± 1.3 years in the study group and 8.7 ± 1.3 years in the control group. In the study group, 80% had leukocytosis (WBC> 10 000), 64% had elevated ESR, and 70.6% had elevated CRP. However, in the control group (nonspecific abdominal pain), 17.3% had leukocytosis, 25.3% had elevated ESR, and 26.6% had elevated CRP.
Conclusion The results of our studies showed that inflammatory markers in patients with acute appendicitis are significantly higher than those in children who have nonspecific abdominal pain. Measurement of these markers is valuable in the diagnosis of appendicitis in children. The diagnostic value of CBC is higher than that of ESR and CRP.

Keywords: acute appendicitis, childrens, inflammatory markers (complete blood count, erythrocyte sedimentation rate, and C-reactive protein), leukocytosis