Original scientific paper

https://doi.org/10.11613/BM.2018.030712

The diagnostic accuracy of clinical and laboratory parameters in the diagnosis of acute appendicitis in the adult emergency department population - a case control pilot study

Ivo Soldo ; Surgery Clinic, University Hospital „Sveti Duh“, Zagreb, Croatia
Vanja Radisic Biljak orcid.org/0000-0002-3385-0533 ; Department of Medical Laboratory Diagnostics, University Hospital „Sveti Duh”, Zagreb, Croatia
Branko Bakula ; Surgery Clinic, University Hospital „Sveti Duh“, Zagreb, Croatia
Maja Bakula ; Department of Ophthalmology, University Hospital Centre Zagreb, Zagreb, Croatia
Ana-Maria Simundic ; Department of Medical Laboratory Diagnostics, University Hospital „Sveti Duh”, Zagreb, Croatia

Abstract

Introduction: The evaluation of patients with suspected appendicitis strives to identify all patients with presenting symptoms while minimizing
negative appendectomy rate. The aim of the study was to identify the optimal combination of clinical and laboratory parameters that should facilitate
the emergency department surgeon’s definite decision.
Materials and methods: The study group comprised 120 patients with suspicion of acute appendicitis (AA). In 60 patients the AA diagnosis was
confirmed intraoperatively and by histological analysis. Clinical parameters included: appetite, vomiting, diarrhea, dysuria, signs of localized peritonitis
and pain migration. Measured laboratory parameters were: C-reactive protein (CRP), complete blood count (CBC) and the urine test strip.
Results: The control group of patients were more likely to present following symptoms: no changes in appetite (P < 0.001), diarrhea (P = 0.009)
and dysuria (P = 0.047). CRP and white blood cell count (WBC) were significantly higher in the group with confirmed AA compared to the control
group (44.7 vs. 6.6, and 13.6 ± 3.9 vs. 9.0 ± 3.4, respectively; P < 0.001). The multivariate logistic regression analysis identified lack of appetite (P
= 0.013), absence of diarrhea (P = 0.004), and positive finding of signs of localized peritonitis (P = 0.013), as well as WBCs (P < 0.001) and negative
urine test strip results (P = 0.009) as statistically significant predictors of AA. The highest percentage of correctly classified cases (82%) was achieved
by combination of common clinical exam and basic inexpensive laboratory parameters (WBCs and urine test strip).
Conclusions: Acute appendicitis in the emergency setting may be successfully ruled in based on elevated WBCs and negative urine test strip in
combination with signs of localized peritonitis, lack of appetite and absence of diarrhea. Since CRP did not contribute to the overall diagnostic accuracy,
its use in AA diagnostic protocols is of no value.

Keywords

appendicitis; emergency service; white blood cell count; C-reactive protein; urinalysis

Hrčak ID:

206786

URI

https://hrcak.srce.hr/206786

Publication date:

15.10.2018.

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