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Eur J Pediatr Surg 2020; 30(04): 357-363
DOI: 10.1055/s-0039-1692166
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Value of Fibrinogen to Discriminate Appendicitis from Nonspecific Abdominal Pain in Preschool Children

Marcos Prada-Arias
1   Department of Pediatric Surgery, University Hospital Álvaro Cunqueiro, Vigo, Spain
2   Galicia Sur Health Research Institute, Vigo, Spain
,
Javier Gómez-Veiras
1   Department of Pediatric Surgery, University Hospital Álvaro Cunqueiro, Vigo, Spain
,
Ángel Salgado-Barreira
2   Galicia Sur Health Research Institute, Vigo, Spain
3   Methodology and Statistics Unit, Galicia Sur Health Research Institute, Vigo, Spain
,
José Luis Vázquez
4   Department of Radiology, University Hospital Álvaro Cunqueiro, Vigo, Spain
,
Margarita Montero-Sánchez
1   Department of Pediatric Surgery, University Hospital Álvaro Cunqueiro, Vigo, Spain
2   Galicia Sur Health Research Institute, Vigo, Spain
,
José Ramón Fernández-Lorenzo
2   Galicia Sur Health Research Institute, Vigo, Spain
5   Department of Pediatrics, University Hospital Álvaro Cunqueiro, Vigo, Spain
› Author Affiliations Funding None.
Further Information

Publication History

22 December 2018

23 April 2019

Publication Date:
12 June 2019 (online)

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Abstract

Introduction The aim of this study was to assess the diagnostic value of the biomarker fibrinogen (FB), along with the markers white blood cell (WBC) count, absolute neutrophil count (ANC), and C-reactive protein (CRP), to discriminate appendicitis from nonspecific abdominal pain (NSAP) in preschool children.

Materials and Methods We prospectively evaluated all children aged <5 years admitted for suspected appendicitis at an academic pediatric emergency department during 5 years. Diagnostic accuracy of FB (prothrombin time–derived method), WBC, ANC, and CRP were assessed by the area under the curve (AUC) of the receiver-operating characteristic curve.

Results A total of 82 patients were enrolled in the study (27 NSAP, 17 uncomplicated, and 38 complicated appendicitides). WBC and ANC had moderate diagnostic accuracy for appendicitis versus NSAP (WBC: AUC 0.66, ANC: AUC 0.67). CRP and FB had good diagnostic accuracy for appendicitis versus NSAP (CRP: AUC 0.78, FB: AUC 0.77). WBC and ANC are not useful to discriminate complicated versus uncomplicated appendicitis (WBC: AUC 0.43, ANC: AUC 0.45). CPR and FB had good diagnostic accuracy for complicated versus uncomplicated appendicitis (CRP: AUC 0.80, FB: AUC 0.73).

Conclusion CRP and FB are more useful than WBC and ANC to discriminate appendicitis from NSAP in preschool children. CRP and FB are especially useful to discriminate complicated from uncomplicated appendicitis and NSAP. In a child with suspected appendicitis, a plasma FB level (prothrombin time–derived method) >540 mg/dL is associated with an increased likelihood of complicated appendicitis.

Keywords

appendicitis - nonspecific abdominal pain - preschool children - diagnostic accuracy - fibrinogen

Authors' Contributions

All authors have seen and approved the final version of the article.


 

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