Presented in part at the annual meeting of Pediatric Academic Societies, Toronto, Ontario, Canada, May 2010.
Discriminative Accuracy of Novel and Traditional Biomarkers in Children With Suspected Appendicitis Adjusted for Duration of Abdominal Pain
Article first published online: 15 JUN 2011
© 2011 by the Society for Academic Emergency Medicine
Academic Emergency Medicine
Volume 18, Issue 6, pages 567–574, June 2011
How to Cite
Kharbanda, A. B., Cosme, Y., Liu, K., Spitalnik, S. L. and Dayan, P. S. (2011), Discriminative Accuracy of Novel and Traditional Biomarkers in Children With Suspected Appendicitis Adjusted for Duration of Abdominal Pain. Academic Emergency Medicine, 18: 567–574. doi: 10.1111/j.1553-2712.2011.01095.x
Supported by Grant UL1 RR024156 from the National Center for Research Resources (NICRR), a component of the National Institute of Health (NIH) and NIH Roadmap for Medical Research.
The authors have no potential conflicts of interest to disclose.
Supervising Editor: Bema Bonsu, MD.
- Issue published online: 15 JUN 2011
- Article first published online: 15 JUN 2011
- Received September 9, 2010; revision received December 23, 2010; accepted January 11, 2011.
ACADEMIC EMERGENCY MEDICINE 2011; 18:568–574 © 2011 by the Society for Academic Emergency Medicine
Objectives: The objective was to assess the accuracy of novel and traditional biomarkers in patients with suspected appendicitis as a function of duration of symptoms.
Methods: This was a prospective cohort study, conducted in a tertiary care emergency department (ED). The authors enrolled children 3 to 18 years old with acute abdominal pain of less than 96 hours and measured serum levels of interleukin-6 (IL-6), interleukin-8 (IL-8), C-reactive protein (CRP), white blood cell (WBC) count, and absolute neutrophil count (ANC). Final diagnosis was determined by histopathology or telephone follow-up. Trends in biomarker levels were examined based on duration of abdominal pain. The accuracy of biomarkers was assessed with receiver operating characteristic (ROC) curves. Optimal cut-points and test performance characteristics were calculated for each biomarker.
Results: Of 280 patients enrolled, the median age was 11.3 years (interquartile range [IQR] = 8.6 to 14.8), 57% were male, and 33% had appendicitis. Median IL-6, median CRP, mean WBC count, and mean ANC differed significantly (p < 0.001) between patients with nonperforated appendicitis and those without appendicitis; median IL-8 levels did not differ between groups. In nonperforated appendicitis, median IL-6, WBC, and ANC levels were maximal at less than 24 hours of pain, while CRP peaked between 24 and 48 hours. In perforated appendicitis, median IL-8 levels were highest by 24 hours, WBC count and IL-6 by 24 to 48 hours, and CRP after 48 hours of pain. The WBC count appeared to be the most useful marker to predict appendicitis in those with fewer than 24 or more than 48 hours of pain, while CRP was the most useful in those with 24 to 48 hours of pain.
Conclusions: In this population, the serum levels and accuracy of novel and traditional biomarkers varies in relation to duration of abdominal pain. IL-6 shows promise as a novel biomarker to identify children with appendicitis.