Eur J Pediatr Surg
DOI: 10.1055/s-0041-1732320
Original Article

Determination of Factors to Distinguish MIS-C from Acute Appendicitis in Children with Acute Abdominal Pain

Müjdem Nur Azılı
1  Department of Pediatric Surgery, Ankara City Children's Hospital, Ankara Yildirim Beyazit University, Ankara, Turkey
2  Department of Pediatric Surgery, Ankara City Hospital, Cankaya, Ankara, Turkey
,
1  Department of Pediatric Surgery, Ankara City Children's Hospital, Ankara Yildirim Beyazit University, Ankara, Turkey
2  Department of Pediatric Surgery, Ankara City Hospital, Cankaya, Ankara, Turkey
,
1  Department of Pediatric Surgery, Ankara City Children's Hospital, Ankara Yildirim Beyazit University, Ankara, Turkey
2  Department of Pediatric Surgery, Ankara City Hospital, Cankaya, Ankara, Turkey
,
Ahmet Ertürk
2  Department of Pediatric Surgery, Ankara City Hospital, Cankaya, Ankara, Turkey
,
Elif Emel Erten
2  Department of Pediatric Surgery, Ankara City Hospital, Cankaya, Ankara, Turkey
,
Sabri Demir
2  Department of Pediatric Surgery, Ankara City Hospital, Cankaya, Ankara, Turkey
,
Ayşe Ertoy
2  Department of Pediatric Surgery, Ankara City Hospital, Cankaya, Ankara, Turkey
,
Serhat Emeksiz
3  Department of Pediatric Intensive Care, Ankara Yildirim Beyazit University, Ankara, Turkey
4  Department of Pediatric Intensive Care, Ankara City Hospital, Cankaya, Ankara, Turkey
,
Aslınur Ozkaya Parlakay
5  Department of Pediatric Infection, Ankara Yildirim Beyazit University, Ankara, Turkey
6  Department of Pediatric Infection, Ankara City Hospital, Cankaya, Ankara, Turkey
,
Banu Acar Celikel
7  Department of Pediatric Rheumatology, Ankara City Hospital, Cankaya, Ankara, Turkey
,
Emrah Senel
1  Department of Pediatric Surgery, Ankara City Children's Hospital, Ankara Yildirim Beyazit University, Ankara, Turkey
2  Department of Pediatric Surgery, Ankara City Hospital, Cankaya, Ankara, Turkey
› Author Affiliations

Abstract

Introduction The aim of this study was to make the differential diagnosis between acute appendicitis and multisystem inflammatory syndrome in children (MIS-C) for patients presenting with the complaint of acute abdominal pain (AAP) and to identify the determining factors for the diagnosis of MIS-C.

Materials and Methods Eighty-one children presenting with AAP/suspected AAP were evaluated. Of these, 24 (29.6%) were included in the MIS-C group (MIS-C/g) and 57 were included in the suspected appendicitis group (S-A/g), which consisted of two subgroups: appendicitis group (A/g) and control observation group (CO/g).

Results Comparing MIS-C/g, A/g, and CO/g, duration of abdominal pain (2.4, 1.5, 1.8 days), high-grade fever (38.8, 36.7, 37°C), severe vomiting, and severe diarrhea were higher in MIS-C/g. Lymphocytes count (LC) was lower, while values of C-reactive protein (CRP), ferritin, and coagulopathy were higher in MIS-C/g (p < 0.05). The optimal cutoffs for the duration of abdominal pain was 2.5 days; the duration of fever, 1.5 days; peak value of fever, 39°C; neutrophil count, 13,225 × 1,000 cell/µMoL; LC, 600 × 1,000 cell/µMoL; ferritin, 233 µg/L; and D-dimer, 16.4 mg/L (p < 0.05). The optimal cutoff for CRP was 130 mg/L (sensitivity 88.9, specificity 100%, positive predictive value 100%, NPV, negative predictive value 92.5%, p < 0.001). All patients in MIS-C/g tested positive by serology by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

Conclusion The duration of abdominal pain, presence of high-grade and prolonged fever, and evaluation of hemogram in terms of high neutrophil count and low LC exhibit high sensitivity and negative predictive value for MIS-C presenting with AAP. In case of doubt, inflammatory markers such as CRP, ferritin, D-dimer, and serology for SARS-CoV-2 should be studied to confirm the diagnosis.

Note

Level III evidence.




Publication History

Received: 20 May 2021

Accepted: 10 June 2021

Publication Date:
23 July 2021 (online)

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany