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Int J Surg. 2009 Feb;7(1):74-7. doi: 10.1016/j.ijsu.2008.11.001. Epub 2008 Nov 19.

C-reactive protein estimation does not improve accuracy in the diagnosis of acute appendicitis in pediatric patients.

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Department of General Surgery, Providence Hospital and Medical Centers, Southfield, MI 48075, USA.



Appendectomy is the treatment of choice in acute appendicitis in children. Delayed diagnosis of acute appendicitis in children can lead to complications like perforation. Studies on the diagnostic value of WBC and CRP in establishing the diagnosis of appendicitis have contradictory results. Our study evaluates the role of CRP in diagnosing appendicitis in a pediatric population.


A retrospective chart study on 130 patients aged less than 19 years who had an appendectomy at Sparrow hospital during years 2002-2006 formed the basis for this report. Based on histology appendicitis was classified as simple or perforated (complicated).


Patients (75 boys, 55 girls) were 6-18 years of age (median 14 years). The appendix was normal in 9/130 cases. Appendicitis was simple in 58/130 cases and perforated in 63/130 cases. Overall WBC count had the highest sensitivity in the prediction of (diagnosis) appendicitis at 88% whereas CRP was 69% and, WBC and CRP combined was 60%. PPV of WBC was highest at 0.81 (47/58) for simple appendicitis and 0.93 (59/63) for perforated appendicitis, when compared to CRP at 0.57 (33/58) and 0.81 (51/63); and CRP and WBC combined at 0.45 (26/58) and 0.75 (47/63).


The sensitivity and PPV of WBC were better than CRP alone, or in combination with WBC. We conclude that CRP does not aid in the diagnosis of appendicitis. Simple appendicitis was seen in spite of normal WBC and CRP.

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