Laboratory Tests in Addition to the Alvarado Score in the Management of Acute Appendicitis in School-Age Children

Astra Zviedre 1 , 2 , Arnis Eņģelis 1 , 2 , Pēteris Tretjakovs 3 , Irisa Zīle 4 , 5 , and Aigars Pētersons 1 , 2
  • 1 Department of Pediatric Surgery, University Children’s Hospital, 1004, Rīga, Latvia
  • 2 Department of Pediatric Surgery, Rīga Stradiņš University, 1004, Rīga, Latvia
  • 3 Department of Physiology and Biochemistry, Rīga Stradiņš University, 1007, Rīga, Latvia
  • 4 Department of Research, Statistics and Health Promotion, Centre for Disease Prevention and Control of Latvia, 1005, Rīga, Latvia
  • 5 Department of Public Health and Epidemiology, Rīga Stradiņš University, 1010, Rīga, Latvia


The aim of the study was to determine whether the Alvarado score (AS) together with laboratory tests could be used to distinguish patients with acute appendicitis (AA) from acute mesenteric lymphadenitis (AML). Fifty-seven patients (7–18 years) with suspected AA were included in the prospective study (October 2010 – October 2013). Thirty-one patients underwent surgery for AA and 26 were not treated surgically and were diagnosed AML on ultrasonography. AS, white blood cell count (WBC), C – reactive protein (CRP) and serum cytokines (EGF, IL-10, IL-12(p70), IL-1β, IL-4, IL-6, IL-8, IL-17, MCP-1, TNF-α) were obtained on admission and were compared between groups. Mean age of the 57 patients was 12.9 (SD 3.2). Accuracy (AR) for AS ≥ 7 alone was 73.7% for AA. Modified AS with certain serum cytokines seemed to be a reliable tool for initial differential diagnosis between AA and AML in school-age children. Based on these results, AS ≥ 7, WBC ≥ 10.7 × 103/µL and serum IL-6 ≥ 4.3 pg/mL assessed altogether will yield more sensitivity for AA. Also for further advanced diagnostics, we propose to take into account the serum IL-6, IL-8, MCP-1, CRP cut-off levels in the differential diagnosis between complicated and uncomplicated AA to decide whether the treatment should be conservative or surgical.

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