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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

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 em...

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Autores principales: Soldo, Ivo, Radisic Biljak, Vanja, Bakula, Branko, Bakula, Maja, Simundic, Ana-Maria
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Croatian Society of Medical Biochemistry and Laboratory Medicine 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6214693/
https://www.ncbi.nlm.nih.gov/pubmed/30429680
http://dx.doi.org/10.11613/BM.2018.030712
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author Soldo, Ivo
Radisic Biljak, Vanja
Bakula, Branko
Bakula, Maja
Simundic, Ana-Maria
author_facet Soldo, Ivo
Radisic Biljak, Vanja
Bakula, Branko
Bakula, Maja
Simundic, Ana-Maria
author_sort Soldo, Ivo
collection PubMed
description 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.
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spelling pubmed-62146932018-11-14 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 Soldo, Ivo Radisic Biljak, Vanja Bakula, Branko Bakula, Maja Simundic, Ana-Maria Biochem Med (Zagreb) Original Papers 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. Croatian Society of Medical Biochemistry and Laboratory Medicine 2018-10-15 2018-10-15 /pmc/articles/PMC6214693/ /pubmed/30429680 http://dx.doi.org/10.11613/BM.2018.030712 Text en ©Croatian Society of Medical Biochemistry and Laboratory Medicine. This is an Open Access article distributed under the terms of the Creative Commons Attribution (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Papers
Soldo, Ivo
Radisic Biljak, Vanja
Bakula, Branko
Bakula, Maja
Simundic, Ana-Maria
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
title 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
title_full 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
title_fullStr 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
title_full_unstemmed 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
title_short 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
title_sort diagnostic accuracy of clinical and laboratory parameters in the diagnosis of acute appendicitis in the adult emergency department population - a case control pilot study
topic Original Papers
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6214693/
https://www.ncbi.nlm.nih.gov/pubmed/30429680
http://dx.doi.org/10.11613/BM.2018.030712
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