Features Partner Sites Information LinkXpress hp
Sign In
Advertise with Us

Download Mobile App




Blood Tests Help Identify Children Who Need Appendectomy

By LabMedica International staff writers
Posted on 04 Mar 2015
Appendicitis is the most common abdominal surgical emergency in the pediatric population, yet the diagnosis remains challenging in many cases and the use of laboratory data as a diagnostic adjunct has similarly been associated with relatively low sensitivity, and children with pathology-proven appendicitis can often present with a normal leukocyte count.

Two standard diagnostic tests commonly obtained in children evaluated for abdominal pain—when combined can improve the ability of emergency department physicians and pediatric surgeons to identify those patients who should be sent to the operating room for prompt removal of an inflamed appendix and those who may be admitted for observation, and those who may safely be discharged home.

Medical staff at the Boston Children's Hospital (Boston, MA, USA) conducted a retrospective cohort study of 845 patients, three to 18 years of age, who were evaluated in an emergency department with a chief symptom of abdominal pain between January 1, 2010 and December 31, 2012. More...
Negative (NPV) and positive predictive values (PPV) for appendicitis were calculated for common constellations of US findings and compared with and without the use of laboratory thresholds: white blood cell count (WBC) >9 × 103/mL and polymorphonuclear leukocyte differential (PMN%) >65% for PPV; WBC <9 × 103/mL and PMN% <65% for NPV. Ultrasound reports were reviewed using standardized definitions and case report forms.

Of the 845 children in the study, 393 (46.5%) had appendicitis. An elevated WBC count was found in 348 (62.1%) of these patients, and a PMN% shift was found in 340 (58.5%). In children who did not have appendicitis, the WBC was elevated in 212 (37.9%), and the PMN% shift occurred in 241 (41.5%). The ability to identify children with and without appendicitis was significantly improved when sonography and laboratory findings were paired. The risk of appendicitis rose from 79.1% to 91.3% when laboratory studies indicated a bacterial infection and sonography showed primary signs of appendicitis, such as increased blood flow or a thickening in the wall of the appendix. The risk of appendicitis rose from 89.1% to 96.8% when laboratory results were abnormal and the sonogram showed secondary signs of appendicitis, such as fat near the appendix.

Shawn J. Rangel, MD, MSCE, FACS, the lead study author and pediatric surgeon said, “Any institution can read our study and readily reproduce what we did. We are not advocating that other hospitals adopt our sonographic categories or laboratory value cut-offs for WBC and PMN values, but rather to work collaboratively with their radiologists and emergency room physicians to develop their own approach for categorizing sonographic findings in their patients with suspected appendicitis, and then develop risk profiles that are tailor-made for their patients after incorporation of their institution's laboratory data. Institutions can use the risk profiles as educational vehicles and clinical guidelines decision tools to help emergency department physicians and surgeons avoid unnecessary computed tomography (CT) scans and admissions for observation for very low-risk patients, and avoid treatment delays in very high-risk patients.” The study was published online on January 30, 2015, in the Journal of the American College of Surgeons.

Related Links:

Boston Children's Hospital



New
Gold Member
Immunochromatographic Assay
CRYPTO Cassette
3-Part Differential Hematology Analyzer
Swelab Alfa Plus Sampler
New
Gold Member
Radial Immunodiffusion Assay
Radial Immunodifusion - C3 ID
New
Sperm Quality Analyis Kit
QwikCheck Beads Precision and Linearity Kit
Read the full article by registering today, it's FREE! It's Free!
Register now for FREE to LabMedica.com and get access to news and events that shape the world of Clinical Laboratory Medicine.
  • Free digital version edition of LabMedica International sent by email on regular basis
  • Free print version of LabMedica International magazine (available only outside USA and Canada).
  • Free and unlimited access to back issues of LabMedica International in digital format
  • Free LabMedica International Newsletter sent every week containing the latest news
  • Free breaking news sent via email
  • Free access to Events Calendar
  • Free access to LinkXpress new product services
  • REGISTRATION IS FREE AND EASY!
Click here to Register








Channels

Molecular Diagnostics

view channel
Image: The ONC IN-CYT platform leverages cross indication biomarker cyto-signatures (Photo courtesy of OraLiva)

AI-Powered Cytology Tool Detects Early Signs of Oral Cancer

Each year, 54,000 Americans are diagnosed with oral cancer, yet only 28% of cases are identified at an early stage, when the five-year survival rate exceeds 85%. Most diagnoses occur in later stages, when... Read more

Immunology

view channel
Image: PD-1 protein blockade is the standard treatment for advanced melanoma among the different types of immunotherapy (Photo courtesy of 123RF)

Precision Tool Predicts Immunotherapy Treatment Failure in Melanoma Patients

Melanoma, though accounting for only about 4% of skin tumors, is the deadliest form of skin cancer due to its high potential to metastasize. While immunotherapy, especially PD-1 protein blockade, has revolutionized... Read more

Pathology

view channel
Image: Researchers have developed a novel method to analyze tumor growth rates (Photo courtesy of Adobe Stock)

Novel Method To Analyze Tumor Growth Rates Helps Tracks Progression Between Diagnosis and Surgery

Patients diagnosed with breast cancer often worry about how quickly their tumors grow while they wait for surgery, and whether delays in treatment might allow the disease to spread beyond the point of cure.... Read more
Copyright © 2000-2025 Globetech Media. All rights reserved.