Diagnostic accuracy of white cell count and C-reactive protein for assessing the severity of paediatric appendicitis

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Abstract
Objectives: Simple investigations like white cell count (WCC) and C-reactive protein (CRP) may help to improve the accuracy of diagnosis in paediatric appendicitis. We evaluated the diagnostic accuracy of WCC and CRP for the severity of acute appendicitis in children. Design: Cross-sectional study. Setting: This study was conducted on all children who underwent open appendectomy from January 2007 to December 2008 at a District General Hospital. Data regarding demographics, WCC, CRP, histology and postoperative complications were analysed. Participants: All children who underwent open appendectomy during the study period. Main outcome measures: Diagnostic accuracy of WCC and CRP for simple acute appendicitis and a perforated appendix. Results: Out of 204 patients, 112 (54.9%) were girls. At surgery, appendix was grossly inflamed in 175 of which 32 had perforation. Histology revealed simple acute appendicitis in 135 (66.2%) and gangrenous appendicitis in 32 (15.7%). The rest were normal. The duration of symptoms, temperature, length of stay, WCC and CRP were significantly worse in the perforated group ( P value <0.05). Postoperative complications included wound infection ( n = 18), pelvic collection ( n = 5) and intestinal obstruction ( n = 6); and were more common among patients with a perforated appendix ( P value <0.05). WCC had a higher diagnostic accuracy and higher sensitivity than CRP in diagnosing simple acute appendicitis. The combined sensitivity of WCC and CRP increased to 95% and 100% for the diagnosis of simple acute appendicitis and a perforated appendix, respectively. Conclusion: Accuracy of WCC is higherthan CRP for diagnosing simple acute appendicitis. The combined sensitivity of WCC and CRP increases for simple acute appendicitis as well as a perforated appendix.

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