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Am J Emerg Med. 2017 Jun;35(6):885-888. doi: 10.1016/j.ajem.2017.01.056. Epub 2017 Jan 27.

Lack of utility of measuring serum bilirubin concentration in distinguishing perforation status of pediatric appendicitis.

Author information

1
Maimonides Medical Center, Brooklyn, NY, United States. Electronic address: wbonadio@maimonidesmed.org.
2
Maimonides Medical Center, Brooklyn, NY, United States.

Abstract

BACKGROUND:

Pediatric appendicitis is a common, potentially serious condition. Determining perforation status is crucial to planning effective management.

PURPOSE:

Determine the efficacy of serum total bilirubin concentration [STBC] in distinguishing perforation status in children with appendicitis.

METHODS:

Retrospective review of 257 cases of appendicitis who received abdominal CT scan and measurement of STBC.

RESULTS:

There were 109 with perforation vs 148 without perforation. Although elevated STBC was significantly more common in those with [36%] vs without perforation [22%], the mean difference in elevated values between groups [0.1mg/dL] was clinically insignificant. Higher degrees of hyperbilirubinemia [>2mg/dL] were rarely encountered [5%]. Predictive values for elevated STBC in distinguishing perforation outcome were imprecise [sensitivity 38.5%, specificity 78.4%, PPV 56.8%, NPV 63.4%]. ROC curve analysis of multiple clinical and other laboratory factors for predicting perforation status was unenhanced by adding the STBC variable. Specific analysis of those with perforated appendicitis and percutaneously-drained intra-abdominal abscess which was culture-positive for Escherichia coli showed an identical rate of STBC elevation compared to all with perforation.

CONCLUSIONS:

The routine measurement of STBC does not accurately distinguish perforation status in children with appendicitis, nor discern infecting organism in those with perforation and intra-abdominal abscess.

KEYWORDS:

Appendicitis; Perforation; Serum bilirubin concentration

PMID:
28185747
DOI:
10.1016/j.ajem.2017.01.056
[Indexed for MEDLINE]

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