Role of C-Reactive Protein, White Blood Cell Counts, Bilirubin Levels, and Imaging in the Diagnosis of Acute Appendicitis as a Cause of Right Iliac Fossa Pain

A comparative study on the diagnostic validity of three scoring systems in the diagnosis of acute appendicitis in emergency centres

Background

Considering the inconsistencies on the validity scoring systems in the diagnosis of acute appendicitis, our aim was to compare the accuracy of the three Anderson, Alvarado and Alvarado + CRP scoring systems in the diagnosis of patients with suspected acute appendicitis.

Methods

This was a prospective observational study performed on patients 15–65 years complained of abdominal pain in the RLQ with a high clinical suspicion of acute appendicitis within two years. The scoring systems of Anderson, Alvarado, and Alvarado + CRP were recorded using a pre-prepared questionnaire by a senior emergency medicine assistant. Acute appendicitis was confirmed based on the histopathologic findings. Written informed consent was obtained from all the patients before entering the study.

Results

200 patients were enrolled in the study. In 159 cases diagnosed with appendicitis based on histopathological findings, Anderson, Alvarado, and Alvarado scoring systems were able to identify 121, 152, and 147 cases respectively. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 77%, 19%, 78%, 17 and 64% in Anderson, 95%, 7%, 75%, 30% and 77% in Alvarado, and 92%, 7%, 79%, 20%, and 75% in Alvarado + CRP scoring systems, respectively.

Conclusion

Anderson scoring system had lower diagnostic accuracy than the Alvarado system. The role of CRP as an adjunct test to increase the accuracy of the Alvarado scoring system in the diagnosis of acute appendicitis has been under question. Given the inconsistent results of the scoring systems in the diagnosis of acute appendicitis, there is a need to develop a more precise clinical-paraclinical scoring system for this condition.

Contribution of neutrophil-to-lymphocyte ratio to decisions regarding sur-gical therapy in patients diagnosed with intestinal obstruction

BACKGROUND

Neutrophil-to-lymphocyte ratio (NLR) has been reported to be a valuable diagnostic tool in the decision-making process for surgical procedures in cases requiring urgent intervention. It was also reported that NLR could be used as an independent predictor of septic shock, hospitalization in the intensive care unit, and death in patients with a liver abscess. This study aimed to investigate the contribution of the NLR, which is a cheap and easily calculable marker, to decisions regarding surgical therapy in patients with intestinal obstruction (IO).

METHODS

Ninety-one patients hospitalized with IO were enrolled in this retrospective study. There were two groups: a surgical therapy group and a conservative therapy group. Complete blood count (CBC) parameters and NLR values were statistically evaluated to determine whether there was any difference between the groups.

RESULTS

The results obtained from the initial CBC tests were compared between the patients receiving surgical therapy (n =30) and conservative therapy (n =61). There was no statistically significant difference in white blood cell counts between the groups (p =0.225). However, there was a statistically significant difference in NLR values between the patients receiving surgical and conservative therapy (p =0.023).

CONCLUSION

Similar to previous studies investigating other inflammation criteria, we found that high NLR values were statistically significant in favor of the surgical therapy group in determining the need for surgery in ileus cases. The data obtained in our study demonstrate that the NLR measurement contributes to early decision-making concerning surgical therapy in patients with IO at the time of their initial admission to the emergency department. HIPPOKRATIA 2019, 23(4): 160-164.