ROLE OF SIMPLE INFLAMMATORY MARKERS IN DIAGNOSIS OF ACUTE APPENDICITIS IN CHILDREN

Abstract

Appendicitis is the most common abdominal surgical emergency. Acute appendicitis is accounting for 10% of all abdominal surgeries and one third of all pediatrics hospital admissions with acute abdominal pain. Not all patients present in a typical manner. Children may present with different and nonspecific symptoms and the risk of progression to perforation in children is high. Despite the introduction of sonography (US) and computed tomography (CT), the accuracy of diagnosis has improved only marginally highlighting the need for better diagnostic tools. Appendectomy is the therapy of choice in children Specialist investigations should not delay definitive treatment. Wound infections can be decreased with the use of perioperative antibiotics. Inflammatory markers such as White Blood Count (WBC) or serum CRP concentration are simple and useful tests. WBC count had a high sensitivity In patients with symptoms lasted less than 24 hours while in those patient with symptoms lasted more than 24 hours CRP had a high sensitivity. The combined presence of normal WBCC and CRP in a patient makes the diagnosis of acute appendicitis highly unlikely. Total Leukocytic Count (TLC) is easily available test and not expensive. Young children have less ability to understand or articulate their developing symptomatology. Therefore, they more commonly present with perforation. Various systems of classification and scoring have been created to reduce the time needed for diagnosis Variations in the position of the appendix, age of the patient and degree of inflammation make the clinical presentation of appendicitis variable. In our study clinical diagnosis was found to be correct in 80% of cases and hence the rate of negative laparotomies for acute appendicitis in our study is 20%. The diagnostic value of TLC is increased when combined with neutrophilia and raised C-reactive proteins and in our study: DIAGNOSTIC ACCURACY of WBC count was 74%. DIAGNOSTIC ACCURACY of neutrophil was 72%. DIAGNOSTIC ACCURACY of C-reactive protein was 88%. DIAGNOSTIC ACCURACY of combining C-reactive protein, WBC count and neutrophil count 100%. To strengthen and confirm the statistical and clinical results of our study we recommend that large number of cases to be enrolled in similar studies.