Significant change between primary and repeated serum laboratory tests at different time points in pediatric appendicitis
Li, Yu-Cheng; Chen, Chan-Yu; Huang, Min-Yi; Wu, Kang-Hsi; Yang, Wen-Chieh; Wu, Han-Ping

European Journal of Emergency Medicine. 19(6):395-399, December 2012.

Abstract:
Objective: The aim of the work is to determine whether the change between primary and repeated serum inflammatory markers measured 8–12 h later may improve diagnostic accuracy in pediatric appendicitis.

Methods: The study group comprised 258 pediatric patients with clinically suspected appendicitis admitted to the pediatric emergency department from 2005 to 2007. The significant changes in serum parameters between primary and repeated examinations were selected as the discriminating variables. The receiver operating characteristic curves were used to determine the cut-off values of the changes between two examinations in predicting appendicitis.

Results: Receiver operating characteristic analysis showed that the cut-off values for the change in total neutrophils (3.0%) on the first day after the onset of symptoms (day 1), the changes in C-reactive protein concentration (4.5 mg/l) and in bands (1%) on day 2, and the change in C-reactive protein concentration (15.0 mg/l) on day 3 were significant serum parameters in predicting pediatric appendicitis.

Conclusion: Repeated serum laboratory tests at different time points during the progression of acute appendicitis may be helpful in predicting pediatric appendicitis in the pediatric emergency department.