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Revista chilena de cirugía

versão On-line ISSN 0718-4026


BELTRAN, MARCELO A et al. White blood cell count and C reactive protein for the diagnosis of acute appendicitis in children. Rev Chil Cir [online]. 2007, vol.59, n.1, pp.38-45. ISSN 0718-4026.

Background: White blood cell count (WBC) and C-reactive protein (CRP) at different cutoff values may have a predictive value for the diagnosis of appendicitis in children. Aim: To determine the value of WBC and CRP for the diagnosis of appendicitis and for the differentiation of simple from perforated appendicitis. Material and Methods: We studied 198 patients (aged 2 to 14 years, 96 males) operated for appendicitis divided in 4 groups according to the lapse between the onset of symptoms and diagnosis (12 hours or less, 13 to 24 hours, 25 to 48 hours and more than 48 hours). The gold standard for the diagnosis was the pathological study of the surgical piece. Receiver operating characteristic curves were constructed for CRP and WBC; the best cutoff points were used to calculate the sensitivity, specificity and diagnostic accuracy to discriminate patients with and without appendicitis, and patients with simple and perforated appendicitis. Results: At a cut off point ranging from 14600 to 15400 cells/mm3, the sensitivity and specificity of WBC to differentiate children with an without appendicitis ranged from 0.9 to 1 and from 0.2 to 0.4 respectively, in the different groups of children studied. The sensitivity and specificity for CRP, at a cut off point ranging from 4.7 and 9.8 mg/dl, ranged 0.9 to 1 and from 0.2 to 0.4 mg/dl respectively, in the different groups. Sensitivity and specificity values did not change significantly when both WBC count and PCR were considered together. The specificity of WBC and CRP, individually or together, to differentiate patients with simple and perforated appendicitis is high but the sensitivity is low. Conclusions: WBC and CRP have a good sensitivity but a low specificity for the diagnosis of appendicitis. For the differentiation between simple and perforated appendicitis, these laboratory values have a high specificity but a low sensitivity

Palavras-chave : Acute appendicitis; white blood cell count; C reactive protein.

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