Surgery Clinic, University Hospital "Sveti Duh", Zagreb, Croatia.
Department of Medical Laboratory Diagnostics, University Hospital "Sveti Duh", Zagreb, Croatia.
Biochem Med (Zagreb). 2018 Oct 15;28(3):030712. doi: 10.11613/BM.2018.030712.
The evaluation of patients with suspected appendicitis strives to identify all patients with presenting symptoms while minimizing negative appendectomy rate. The aim of the study was to identify the optimal combination of clinical and laboratory parameters that should facilitate the emergency department surgeon's definite decision.
The study group comprised 120 patients with suspicion of acute appendicitis (AA). In 60 patients the AA diagnosis was confirmed intraoperatively and by histological analysis. Clinical parameters included: appetite, vomiting, diarrhea, dysuria, signs of localized peritonitis and pain migration. Measured laboratory parameters were: C-reactive protein (CRP), complete blood count (CBC) and the urine test strip.
The control group of patients were more likely to present following symptoms: no changes in appetite (P < 0.001), diarrhea (P = 0.009) and dysuria (P = 0.047). CRP and white blood cell count (WBC) were significantly higher in the group with confirmed AA compared to the control group (44.7 . 6.6, and 13.6 ± 3.9 . 9.0 ± 3.4, respectively; P < 0.001). The multivariate logistic regression analysis identified lack of appetite (P = 0.013), absence of diarrhea (P = 0.004), and positive finding of signs of localized peritonitis (P = 0.013), as well as WBCs (P < 0.001) and negative urine test strip results (P = 0.009) as statistically significant predictors of AA. The highest percentage of correctly classified cases (82%) was achieved by combination of common clinical exam and basic inexpensive laboratory parameters (WBCs and urine test strip).
Acute appendicitis in the emergency setting may be successfully ruled in based on elevated WBCs and negative urine test strip in combination with signs of localized peritonitis, lack of appetite and absence of diarrhea. Since CRP did not contribute to the overall diagnostic accuracy, its use in AA diagnostic protocols is of no value.
评估疑似阑尾炎患者的目的是在尽量降低阴性阑尾切除率的同时，识别所有出现症状的患者。本研究旨在确定最佳的临床和实验室参数组合，以帮助急诊科医生做出明确诊断。
本研究纳入 120 例疑似急性阑尾炎（AA）的患者。其中 60 例患者术中及组织学分析确诊为 AA。临床参数包括：食欲、呕吐、腹泻、尿痛、局部腹膜炎体征及疼痛转移。实验室参数包括：C 反应蛋白（CRP）、全血细胞计数（CBC）和尿液检测条。
对照组患者更可能出现以下症状：无食欲变化（P<0.001）、腹泻（P=0.009）和尿痛（P=0.047）。与对照组相比，确诊 AA 组的 CRP 和白细胞计数（WBC）显著升高（44.7±6.6 和 13.6±3.9；P<0.001）。多变量逻辑回归分析确定缺乏食欲（P=0.013）、无腹泻（P=0.004）和局部腹膜炎体征阳性（P=0.013），以及 WBC（P<0.001）和尿液检测条阴性（P=0.009）为 AA 的统计学显著预测因子。最常见的临床检查和基本的廉价实验室参数（WBC 和尿液检测条）相结合，可正确分类 82%的病例。
在急诊情况下，结合局部腹膜炎体征、缺乏食欲和无腹泻，以及白细胞计数升高和尿液检测条阴性，可成功诊断急性阑尾炎。由于 CRP 对总体诊断准确性没有贡献，因此在 AA 诊断方案中使用 CRP 没有价值。
