Pediatr Emerg Med J.
2017 Dec;4(2):51-57. 10.22470/pemj.2017.00101.
High white blood cell count and erythrocyte sedimentation rate are associated with perforated appendicitis in children
- Affiliations
-
- 1Department of Emergency Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea. drme@catholic.ac.kr
- 2Department of Emergency Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
- KMID: 2402328
- DOI: http://doi.org/10.22470/pemj.2017.00101
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.
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