The Association Between C-Reactive Protein Levels and Pediatric Appendicitis Score and the Severity of Appendicitis in Children
Authors: Jill Fennell, Heather M Territo, Nadya Telt, Brian H Wrotniak, Rafal Kozielski, Earl Pape, Michelle Penque
Published in: Journal of Emergency Medicine, 2023 December 10
Conclusions:
- There is a positive correlation between higher CRP levels, PAS, and increased histologic inflammation of the appendix. This suggests CRP and PAS could be instrumental in guiding treatment decisions for children with appendicitis.
Methods:
- A prospective observational study involving patients diagnosed with acute appendicitis via computed tomography or ultrasound.
- Participants underwent CRP testing, PAS calculation, and histologic appendix evaluation, with inflammation categorized as simple, suppurative, gangrenous, or perforated.
Results:
- Out of 163 patients, there were significant differences (p < 0.002) in CRP levels and PAS across the four histologic categories of appendicitis.
- Simple appendicitis: Mean CRP 2.95 mg/L, PAS 3.9
- Suppurative appendicitis: Mean CRP 26.89 mg/L, PAS 6.5
- Gangrenous appendicitis: Mean CRP 91.11 mg/L, PAS 7.5
- Perforated appendicitis: Mean CRP 154.17 mg/L, PAS 7
- Adjustments for age, race, and sex did not alter the statistical significance (p < 0.002).
- A combined score of PAS ≥ 8 and CRP > 40 mg/L had a specificity of 91.2% and a positive predictive value of 72.7% for complicated appendicitis.