The diagnostic value of C-reactive protein, white blood cell count and neutrophil percentage in childhood appendicitis

OBJECTIVE: To analyze the value of C-reactive protein (CRP), total white blood cell count (WBC), and neutrophil percentage in the diagnosis of suspected cases of childhood appendicitis.

METHODS: Prospective study of 216 patients admitted with a history of suspected acute appendicitis, between October 2001 through to May 2002, Al Fateh Teaching Hospital for Children, Benghazi, Libya. Blood samples for estimation of CRP, total WBC and neutrophil percentage were sent immediately to the laboratory. Sensitivity, specificity, positive predictive and negative predictive values were calculated, for each test and in combination.

RESULTS: There were 139 male and 77 female patients, the age range was 3-13-years, 135 patients were operated. Those who had appendicitis, we had 114 patients with positive CRP values of more than (8 microgram/ml), and 109 patients had total WBC count of more than (11,000/microL), and 111 patients with neutrophil percentage more of than 75%. One hundred and twelve patients out of 130 with appendicitis had the triple tests positive, and only 8 out of 86 patients without appendicitis had the triple tests positive. The sensitivity, specificity, positive and negative predictive values of the 3 tests in combination were 86%, 90.7%, 93% 81.2%.

CONCLUSION: Evaluation of the clinical symptoms and signs combined with the triple tests can improve the diagnostic accuracy and significantly reduce the incidence of perforation and the rate of negative laparotomy.