Diagnostic value of blood inflammatory markers for detection of acute appendicitis in children

Data were collected prospectively on 211 consecutive children. Laparotomy was performed for suspected AA for 189 patients. Patients were subdivided into groups: nonsurgical abdominal pain, early appendicitis, phlegmonous or gangrenous appendicitis, perforated appendicitis.White blood cell count (WBC), serum C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor α (TNF-α), acid α1-glycoprotein (α1GP), endotoxin, and erythrocyte sedimentation reaction (ESR) were estimated ad the time of admission. The diagnostic performance was analyzed using receiver operating characteristic (ROC) curves.WBC count, CRP and IL-6 correlated significantly with the severity of appendiceal inflammation. Identification of children with severe appendicitis was supported by IL-6 or CRP but not WBC. Between IL-6 and CRP, there were no significant differences in diagnostic use.Laboratory results should be considered to be integrated within the clinical assessment. If used critically, CRP and IL-6 equally provide surgeons with complementary information in discerning the necessity for urgent operation.It is generally accepted that appendectomy is the therapy of choice in children. Conservative management, as evaluated in some studies of adult patients [1] is not established for children. A delay in diagnosis of acute appendicitis (AA) is associated with increased risk of perforation and further complications. On the other hand in young children, geriatric patients, and in adolescent females, the negative appendectomy rate may be as high as 50 % [2]. Many attempts have been made to determine ways of decreasing the negative laparotomy rate after a clinical suspicion of AA. Under this background it would be very important to differentiate mild early appendicitis from nonspecific abdominal pain. However, despite complete clinical history, physical examination, and the usual laboratory studies clear decision aids for detection of early AA are lacking. Ultrasonography has been used incr