Leucocyte count in children with complicated and uncomplicated acute appendicitis: a comparative study
DOI:
https://doi.org/10.18203/2349-2902.isj20195178Keywords:
Leucocytosis, Histopathology, PerforationAbstract
Background: Identification of complicated and uncomplicated acute appendicitis is important in children. In acute appendicitis, along with clinical evaluation and staging, many laboratory tests have been used. The aim of the study was to compare total leucocyte count in children with uncomplicated and complicated acute appendicitis in different age groups.
Methods: Retrospective cohort study was performed in children who underwent appendicectomy, in a Government tertiary care institution between January 2017 and December 2018. 206 patients were divided into complicated and uncomplicated appendicitis. Total leucocyte count at time of admission was compared according to age. Unpaired t test and Chi-square test were used for statistical analysis.
Results: There were 136 males and 70 females. 107 patients (51.94%) had complicated and 99 (48.06%) had uncomplicated appendicitis. Mean leucocyte count per µl in uncomplicated appendicitis was 18993±3540 in <5 years, 17155±3386 in 5-10 years and 15833±3613 in 10-15 years. The mean leucocyte count for complicated appendicitis was 19974±3658 in <5 years, 17727±4487 in 5-10 years and 17220±3411 in 10-15 years age group. In 10-15 years group, patients with complicated acute appendicitis had statistically significant higher values of mean total leucocyte count.
Conclusions: Total leucocyte count can be used as marker of severity of acute appendicitis in children older than 10 years. In children with clinical suspicion of acute appendicitis, total leucocyte count >20000 per µl signifies complicated appendicitis in all age groups.
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References
Christoph B, Turial S, Kirkoatrick J. Acute appendicitis: a continuing challenge for both clinicians and pathologists. Afr J Paediatric Surg. 2011;8(2):145.
Flum DR, Koepsell T. The clinical and economic corelates of misdiagnosed appendicitis: nationwide analysis. Arch Surg. 2002;137(7):799-804.
Graff L, Russell J, Seashore J, Tate J, Elwell A, Prete M, et al. False- negative and false-positive errors in abdominal pain evaluation: failure to diagnose acute appendicitis and unnecessary surgery. Acad Emerg Med. 2000;7(11):1244-552.
Cheong LH, Emil S. Outcomes of paediatric appendicitis: an international comparison of the United States and Canada. JAMA Surg. 2014;149(1):50-5.
Saluja S, Sun T, Mao J, Steigman SA, Oh PS, Yeo HL, et al. Early vs late management of complicated appendicitis in children: a state wide database analysis with one year follow up. J Pediatr Surg. 2018;53(7):1339-44.
Malik AA, Bari SU. Conservative management of acute appendicitis. J Gastrointest Surg. 2009;13(5):966-70.
Alnaser MKH, Hassan QA, Hindosh LN. Effectiveness of conservative management of uncomplicated acute appendicitis: a single hospital based prospective study. Int J Surg. 2018;10:1-4.
Knaapen M, van der Lee JH, Heij HA, van Heurn ELW, Bakx R, Gorter RR. Clinical recovery in children with uncomplicated appendicitis undergoing non operative treatment: secondary analysis of a prospective study. Eur J Pediatr. 2019;178:235.
Ohle R, O’Reilly F, O’Brien K, Fahey T, Dimitrov BD. The Alvarado score for predicting acute appendicitis: a systematic review. BMC Med. 2011;139:9.
Kim E, Subhas G, Mittal VK, Golladay ES. C-reactive protein estimation does not improve accuracy in diagnosis of acute appendicitis in paediatric patients. Int J Surg. 2009;7(1):74-7.
Guraya SY, Al-Tuwaijri TA, Khairy GA, Murashid KR. Validity of leucocyte count to predict the severity of acute appendicitis. Saudi Med J. 2005;26(12):1945-7.
Rothrock SG, Pagane J. Acute appendicitis in children: emergency department diagnosis and management. Ann Emerg Med. 2000;36(1):39-51.
Shogilev DJ, Duus N, Odom SR, Shapiro NI. Diagnosing appendicitis: evidence-based review of the diagnostic approach in 2014. West J Emerg Med. 2014;15(7):859-71.
Soldin SJ, Brugnara C, Wong E. Pediatric reference ranges. Seattle: WA7 Pathology Associates Medical Laboratories; 2000.
Monsalve S, Ellwanger A, Montedonico S. White blood cell count and C-reactive protein together remain useful for diagnosis and staging of acute appendicitis in children. S Afr Med J. 2017;107(9):773-6.
Virmani S, Prabhu PS, Sundeep PT, Kumar V. Role of labarotory markers in predicting severity of acute appendicitis. Afr J Paediatric Surg. 2018;15(1):1-4.
Wilcox RT, Traverso LW. Have the evaluation and treatment of acute appendicitis changed with new technology?. Surg Clin North Am. 1997;77:1355-70.
Stefanutti G, Ghirardo V, Gamba P. Inflammatory markers in acute appendicitis in children: are they useful?. J Pediatric Surg. 2007;42(5):773-6.
Gronross JM. Do normal leucocyte count and C reactive protein value exclude acute appendicitis in children? Acta Paeditr. 2001;90(6):649-51.
Yu CW, Juan Li. Systematic review and meta-analysis of the diagnostic accuracy of procalcitonin, C-reactive protein and white blood cell count for suspected acute appendicitis. Br J Surg. 2013;100(3):322-9.
Beltran MA, Almonacid J, Vicencio A, Gutierrez J, Cruces KS, Cumsille MA. Predicative value of white blood cell count and C reactive protein in children with appendicitis. J Pediatr Surg. 2007;42(7):1208-14.
Mallick MS. Appendicitis in preschool children: a continuing clinical challenge. A retrospective study. Int J Surg. 2008;6:371-3.
Paajanen H, Mansikka A, Laato M, Kettunen J, Kostiainen S. Are serum inflammatory markers age independent in acute appendicitis. J Am Coll Surg. 1997;184:303-8.
Rentea RM, Peter SDS, Snyder CL. Pediatric appendicitis: state of the art review. Pediatr Surg Int. 2017;33(3):269-83.
