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Added value of CRP to clinical features when assessing appendicitis in children

BACKGROUND: The diagnostic value of C-reactive protein (CRP) for appendicitis in children has not been evaluated in primary care. As biochemical responses and differential diagnoses vary with age, separate evaluation in children and adults is needed. OBJECTIVES: To determine whether adding CRP to sy...

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Autores principales: Blok, Guus C. G. H., Nikkels, Eelke D., van der Lei, Johan, Berger, Marjolein Y., Holtman, Gea A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Taylor & Francis 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9103685/
https://www.ncbi.nlm.nih.gov/pubmed/35535699
http://dx.doi.org/10.1080/13814788.2022.2067142
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author Blok, Guus C. G. H.
Nikkels, Eelke D.
van der Lei, Johan
Berger, Marjolein Y.
Holtman, Gea A.
author_facet Blok, Guus C. G. H.
Nikkels, Eelke D.
van der Lei, Johan
Berger, Marjolein Y.
Holtman, Gea A.
author_sort Blok, Guus C. G. H.
collection PubMed
description BACKGROUND: The diagnostic value of C-reactive protein (CRP) for appendicitis in children has not been evaluated in primary care. As biochemical responses and differential diagnoses vary with age, separate evaluation in children and adults is needed. OBJECTIVES: To determine whether adding CRP to symptoms and signs improves the diagnosis of appendicitis in children with acute abdominal pain in primary care. METHODS: A retrospective cohort study in Dutch general practice. Data was collected from the Integrated Primary Care Information database between 2010 and 2016. We included children aged 4–18 years, with no history of appendicitis, presenting with acute abdominal pain, and having a CRP test. Initial CRP levels were related to the specialist’s diagnosis of appendicitis, and the test’s characteristics were calculated for multiple cut-offs. The value of adding CRP to signs and symptoms was analysed by logistic regression. RESULTS: We identified 1076 eligible children, among whom 203 were referred for specialist evaluation and 70 had appendicitis. The sensitivity and specificity of a CRP cut-off ≥10 mg/L were 0.87 (95%CI, 0.77–0.94) and 0.77 (95%CI, 0.74–0.79), respectively. When symptoms lasted > 48 h, this sensitivity increased to 1.00. Positive predictive values for CRP alone were low (0.18–0.38) for all cut-off values (6–100 mg/L). Adding CRP increased the area under the curve from 0.82 (95%CI, 0.78–0.87) to 0.88 (95%CI, 0.84–0.91), and decision curve analysis confirmed that its addition provided the highest net benefit. CONCLUSION: CRP adds value to history and physical examination when diagnosing appendicitis in children presenting acute abdominal pain in primary care. Appendicitis is least likely if the CRP value is < 10 mg/L and symptoms have been present for > 48 h.
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spelling pubmed-91036852022-05-14 Added value of CRP to clinical features when assessing appendicitis in children Blok, Guus C. G. H. Nikkels, Eelke D. van der Lei, Johan Berger, Marjolein Y. Holtman, Gea A. Eur J Gen Pract Original Article BACKGROUND: The diagnostic value of C-reactive protein (CRP) for appendicitis in children has not been evaluated in primary care. As biochemical responses and differential diagnoses vary with age, separate evaluation in children and adults is needed. OBJECTIVES: To determine whether adding CRP to symptoms and signs improves the diagnosis of appendicitis in children with acute abdominal pain in primary care. METHODS: A retrospective cohort study in Dutch general practice. Data was collected from the Integrated Primary Care Information database between 2010 and 2016. We included children aged 4–18 years, with no history of appendicitis, presenting with acute abdominal pain, and having a CRP test. Initial CRP levels were related to the specialist’s diagnosis of appendicitis, and the test’s characteristics were calculated for multiple cut-offs. The value of adding CRP to signs and symptoms was analysed by logistic regression. RESULTS: We identified 1076 eligible children, among whom 203 were referred for specialist evaluation and 70 had appendicitis. The sensitivity and specificity of a CRP cut-off ≥10 mg/L were 0.87 (95%CI, 0.77–0.94) and 0.77 (95%CI, 0.74–0.79), respectively. When symptoms lasted > 48 h, this sensitivity increased to 1.00. Positive predictive values for CRP alone were low (0.18–0.38) for all cut-off values (6–100 mg/L). Adding CRP increased the area under the curve from 0.82 (95%CI, 0.78–0.87) to 0.88 (95%CI, 0.84–0.91), and decision curve analysis confirmed that its addition provided the highest net benefit. CONCLUSION: CRP adds value to history and physical examination when diagnosing appendicitis in children presenting acute abdominal pain in primary care. Appendicitis is least likely if the CRP value is < 10 mg/L and symptoms have been present for > 48 h. Taylor & Francis 2022-05-10 /pmc/articles/PMC9103685/ /pubmed/35535699 http://dx.doi.org/10.1080/13814788.2022.2067142 Text en © 2022 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. https://creativecommons.org/licenses/by/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Blok, Guus C. G. H.
Nikkels, Eelke D.
van der Lei, Johan
Berger, Marjolein Y.
Holtman, Gea A.
Added value of CRP to clinical features when assessing appendicitis in children
title Added value of CRP to clinical features when assessing appendicitis in children
title_full Added value of CRP to clinical features when assessing appendicitis in children
title_fullStr Added value of CRP to clinical features when assessing appendicitis in children
title_full_unstemmed Added value of CRP to clinical features when assessing appendicitis in children
title_short Added value of CRP to clinical features when assessing appendicitis in children
title_sort added value of crp to clinical features when assessing appendicitis in children
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9103685/
https://www.ncbi.nlm.nih.gov/pubmed/35535699
http://dx.doi.org/10.1080/13814788.2022.2067142
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