The Association Between C-Reactive Protein Levels and Pediatric Appendicitis Score and the Severity of Appendicitis in Children

Jill Fennell; Heather M Territo; Nadya Telt; Brian H Wrotniak; Rafal Kozielski; Earl Pape; Michelle Penque

doi:10.1016/j.jemermed.2023.11.016

The Association Between C-Reactive Protein Levels and Pediatric Appendicitis Score and the Severity of Appendicitis in Children

J Emerg Med. 2024 Apr;66(4):e508-e515. doi: 10.1016/j.jemermed.2023.11.016. Epub 2023 Dec 9.

Authors

Jill Fennell¹, Heather M Territo¹, Nadya Telt¹, Brian H Wrotniak², Rafal Kozielski³, Earl Pape³, Michelle Penque¹

Affiliations

¹ Department of Pediatrics, Division of Pediatric Emergency Medicine, UBMD Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, John R. Oishei Children's Hospital, Buffalo, New York.
² Department of Pediatrics, Division of Pediatric Emergency Medicine, UBMD Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, John R. Oishei Children's Hospital, Buffalo, New York; Masters of Public Health Program, D'Youville College, Buffalo, New York.
³ Department of Pathology and Anatomical Sciences, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, John R. Oishei Children's Hospital, Buffalo, New York.

PMID: 38429214
DOI: 10.1016/j.jemermed.2023.11.016

Abstract

Background: Acute appendicitis is a common cause of abdominal pain leading to emergent abdominal surgery in children. C-reactive protein (CRP), an inflammatory marker typically elevated in acute appendicitis, and Pediatric Appendicitis Score (PAS), a clinical scoring system used for the diagnosis of appendicitis, have the potential to predict the severity of inflammation of the appendix. This may be useful in helping the physician make a treatment plan prior to surgery.

Objective: The purpose of this study was to assess whether CRP value and PAS differ with the extent of inflammation of the appendix seen on histologic examination.

Methods: This was a prospective observational study of patients diagnosed with acute appendicitis via computed tomography or ultrasound. Enrolled patients had CRP levels drawn, PAS calculated, and appendix pathology reviewed. Appendix pathology was categorized by the pathologist on the basis of the level of inflammation: simple, suppurative, gangrenous, and perforated.

Results: One hundred sixty-three patients were enrolled. CRP levels and PAS were statistically different (p < 0.002) among the four pathology classifications. Patients with simple appendicitis (n = 3) had a mean CRP of 2.95 mg/L and PAS of 3.9, patients with suppurative appendicitis (n = 99) had a mean CRP of 26.89 mg/L and PAS of 6.5, patients with gangrenous appendicitis (n = 56) had a mean CRP of 91.11 mg/L and PAS of 7.5, and patients with perforated appendicitis (n = 6) had a mean CRP of 154.17 mg/L and PAS of 7. The results remained statistically significant (p < 0.002) after adjusting for age, race, and sex. When combined-PAS ≥ 8 and CRP level > 40 mg/L-the specificity of complicated appendicitis was 91.2% and positive predictive value was 72.7%.

Conclusions: Higher CRP levels and PAS were associated with increased histologic inflammation of the appendix. This study provides preliminary evidence that CRP and PAS could potentially assist in treatment decisions for appendicitis.

Keywords: C-reactive protein; CRP; PAS; Pediatric Appendicitis Score; acute appendicitis; children.

Publication types

Observational Study

MeSH terms

Acute Disease
Appendicitis* / complications
Appendicitis* / diagnosis
Appendix
C-Reactive Protein* / analysis
Child
Humans
Inflammation
Prospective Studies
Sensitivity and Specificity

Substances

C-Reactive Protein