High white blood cell count and erythrocyte sedimentation rate are associated with perforated appendicitis in children.
- Author:
Yoon Ho KIM
1
;
Seon Hee WOO
;
Woon Jeong LEE
;
Seung Hwan SEOL
;
Dae Hee KIM
;
June Young LEE
;
Seung Pill CHOI
Author Information
- Publication Type:Original Article
- Keywords: Blood Sedimentation; Emergencies; Leukocyte Count; Pediatrics; Perforated Appendicitis; Prognosis
- MeSH: Appendicitis*; Blood Sedimentation; C-Reactive Protein; Child*; Emergencies; Emergency Service, Hospital; Humans; Length of Stay; Leukocyte Count*; Leukocytes*; Lymphocyte Count; Nausea; Neutrophils; Pediatrics; Prognosis; Retrospective Studies; ROC Curve; Vomiting
- From:Pediatric Emergency Medicine Journal 2017;4(2):51-57
- CountryRepublic of Korea
- Language:English
- Abstract: PURPOSE: To investigate the predictors of perforated appendicitis (PA) in pediatric patients with appendicitis seen in the emergency department. METHODS: We retrospectively reviewed 564 pediatric patients (< 16 years) who visited the emergency department and subsequently had pathologically confirmed appendicitis from 2005 through 2014. Clinical features, inflammatory markers, including the white blood cell (WBC), neutrophil, and lymphocyte counts, neutrophil-to-lymphocyte ratio, C-reactive protein (CRP) concentration, erythrocyte sedimentation rate (ESR), and the Alvarado score were compared between the patients with and without PA regarding their predictability of PA. RESULTS: Of 564 pediatric patients with appendicitis, 204 (36.2%) had PAs. The patients with PA had longer duration of symptoms and median length of hospital stay, more frequent nausea and vomiting, and higher median WBC and neutrophil counts, neutrophil-to-lymphocyte ratio, ESR, and CRP concentration. Overall, WBC count showed the highest sensitivity of 79.9% and negative predictive value of 82.6%, and CRP concentration had the highest area under the receiver operating characteristic curve of 0.72. Multivariable logistic analysis showed that WBC count > 13.5 × 109/L (odds ratio [OR], 3.27; confidence interval [CI], 1.49–7.18; P = 0.003) and ESR > 15 mm/h (OR, 3.18; 95% CI, 2.13–4.74; P < 0.001) are independent predictors of PA. CONCLUSION: WBC count and ESR might be better predictors of PA in pediatric patients with appendicitis in the emergency department than the Alvarado score and CRP concentration.
