Negative appendicectomy rates in adolescent girls compared with boys: The role of ultrasound and serum inflammatory markers

Abstract

Background Adolescent girls are frequently seen with more differentials for  abdominal pain than boys. We aim to determine if this infers that a negative appendectomy (NA) is more likely in girls, and if the use of ultrasonography
(USS) and inflammatory markers reduce the likelihood of a NA.
Participants and methods Over a 17-year period, we reviewed the histology of appendix specimens removed nonincidentally from adolescents aged 12–16 years. Specimens with normal histology were grouped as NAs. The preoperative white cell count, C-reactive protein and USS were analysed.
Results Data were available for 430 boys and 273 girls. The overall NA rate was 9.1%, with 7.2 and 12.1% in boys and girls, respectively. This represented an increased odds of a NA in girls [odds ratio (OR): 1.77, 95% confidence interval (95% CI): 1.06–2.96; P = 0.030]. When the variance in the preoperative use of USS and inflammatory markers was accounted for, the new odds of a NA in girls compared with boys were now not significantly increased (OR: 2.27, 95% CI:0.09–60.64; P = 0.624). USS did not significantly reduced the odds of a NA (OR: 0.98, 95% CI: 0.48–2.02; P=0.960). There were significantly increased odds of a NA in adolescents with normal white cell count and C-reactive protein (OR: 15.84, 95% CI: 2.12–118.50; P = 0.007).
Conclusion Adolescent girls are more likely to undergo a NA. When inflammatory markers are elevated, this increased likelihood of a NA is not seen in girls, but rather reduced odds of a NA are seen in both girls and boys. adolescents, boys, girls, inflammatory markers, negative appendicectomy, ultrasonography

Keywords: adolescents, boys, girls, inflammatory markers, negative appendicectomy, ultrasonography