Abstract
Introduction The aim of this study was to assess the diagnostic value of the biomarker fibrinogen
(FB), along with the markers white blood cell (WBC) count, absolute neutrophil count
(ANC), and C-reactive protein (CRP), to discriminate appendicitis from nonspecific
abdominal pain (NSAP) in preschool children.
Materials and Methods We prospectively evaluated all children aged <5 years admitted for suspected appendicitis
at an academic pediatric emergency department during 5 years. Diagnostic accuracy
of FB (prothrombin time–derived method), WBC, ANC, and CRP were assessed by the area
under the curve (AUC) of the receiver-operating characteristic curve.
Results A total of 82 patients were enrolled in the study (27 NSAP, 17 uncomplicated, and
38 complicated appendicitides). WBC and ANC had moderate diagnostic accuracy for appendicitis
versus NSAP (WBC: AUC 0.66, ANC: AUC 0.67). CRP and FB had good diagnostic accuracy
for appendicitis versus NSAP (CRP: AUC 0.78, FB: AUC 0.77). WBC and ANC are not useful
to discriminate complicated versus uncomplicated appendicitis (WBC: AUC 0.43, ANC:
AUC 0.45). CPR and FB had good diagnostic accuracy for complicated versus uncomplicated
appendicitis (CRP: AUC 0.80, FB: AUC 0.73).
Conclusion CRP and FB are more useful than WBC and ANC to discriminate appendicitis from NSAP
in preschool children. CRP and FB are especially useful to discriminate complicated
from uncomplicated appendicitis and NSAP. In a child with suspected appendicitis,
a plasma FB level (prothrombin time–derived method) >540 mg/dL is associated with
an increased likelihood of complicated appendicitis.
Keywords
appendicitis - nonspecific abdominal pain - preschool children - diagnostic accuracy
- fibrinogen
