Khan Abu N G A, Sawan Abdel, Likourezos Antonios, Schnellinger Mark, Garcia Estavan
Department of Emergency Medicine, Maimonides Medical Center, 4802 Tenth Avenue, Brooklyn, NY 11219, USA ; Division of Pediatric Emergency Medicine, Morgan Stanley Children Hospital of New York-Presbyterian, 622 West 168th Street, PH 137-1, New York, NY 10032, USA.
Emerg Med Int. 2012;2012:317504. doi: 10.1155/2012/317504. Epub 2012 Dec 5.
Objective. To assess the predictive value of procalcitonin in detecting acute appendicitis (AP) in children, and to determine a cutoff value of procalcitonin which can safely include/exclude the diagnosis of acute appendicitis in children with acute abdominal pain. Methods. Prospective cohort study of children aged 5-17 years presenting to the emergency room with right lower quadrant (RLQ) tenderness and strong suspicion for acute AP. In addition to standard diagnostic workup for acute AP, a quantitative procalcitonin level was measured using immunoluminometric assay. Recursive partitioning model was used to assess the usefulness of procalcitonin in the diagnosis of appendicitis. Results. Of the 50 children studied, 48% were diagnosed to have AP. The mean procalcitonin level was higher among the children with appendicitis (P = 0.3). Using the recursive partitioning model, we identified a cutoff value of procalcitonin level of 0.39 with a likelihood ratio presence of appendicitis 3.25 and absence of appendicitis 0.8. None of the study subjects with procalcitonin level <0.39 and WBC count of <6.76 K had appendicitis. Conclusions. In conjunction with the clinical symptoms, a procalcitonin level and WBC count could be a strong predictor of acute appendicitis in children.
目的。评估降钙素原在检测儿童急性阑尾炎（AP）中的预测价值，并确定一个降钙素原的临界值，该临界值能够安全地纳入/排除急性腹痛儿童的急性阑尾炎诊断。方法。对5至17岁因右下腹（RLQ）压痛且高度怀疑急性AP而就诊于急诊室的儿童进行前瞻性队列研究。除了对急性AP进行标准诊断检查外，还使用免疫发光分析法测量降钙素原定量水平。采用递归划分模型评估降钙素原在阑尾炎诊断中的有用性。结果。在研究的50名儿童中，48%被诊断为AP。阑尾炎患儿的降钙素原平均水平较高（P = 0.3）。使用递归划分模型，我们确定降钙素原水平的临界值为0.39，阑尾炎存在的似然比为3.25，阑尾炎不存在的似然比为0.8。降钙素原水平<0.39且白细胞计数<6.76 K的研究对象均无阑尾炎。结论。结合临床症状，降钙素原水平和白细胞计数可能是儿童急性阑尾炎的有力预测指标。
