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Clinical and laboratory findings in the diagnosis of right lower quadrant abdominal pain: outcome analysis of the APPAC trial

  • Elina Lietzén EMAIL logo , Imre Ilves , Paulina Salminen , Hannu Paajanen , Tero Rautio , Pia Nordström , Markku Aarnio , Tuomo Rantanen , Tommi Kauko , Airi Jartti , Juhani Sand , Jukka-Pekka Mecklin and Juha M. Grönroos
Published/Copyright: March 24, 2016
Clinical Chemistry and Laboratory Medicine (CCLM)
From the journal Clinical Chemistry and Laboratory Medicine (CCLM) Volume 54 Issue 10

Abstract

Background:

The current research on acute appendicitis aims to improve the diagnostics and to clarify to whom antibiotic treatment might be the treatment of choice.

Methods:

The present study is a retrospective analysis of a prospectively collected data in our randomized multicenter trial comparing surgery and antibiotic treatment for acute uncomplicated appendicitis (APPAC trial, NCTO1022567). We evaluated 1321 patients with a clinical suspicion of acute appendicitis, who underwent computed tomography (CT). Age, gender, body temperature, pain scores, the duration of symptoms, white blood cell count (WBC) and C-reactive protein (CRP) were recorded on admission.

Results:

CT confirmed the diagnosis of acute appendicitis in 73% (n=970) and in 27% (n=351) it revealed no or other diagnosis. Acute appendicitis patients had significantly higher WBC levels than patients without appendicitis (median 12.2 and 10.0, respectively, p<0.0001), whereas CRP levels did not differ between the two groups. Ideal cut-off points were assessed with receiver operating characteristic (ROC) curves, but neither these markers or neither their combination nor any clinical characteristic could accurately differentiate between patients with acute appendicitis and those without. The proportion of patients with normal WBC count and CRP was significantly (p=0.0007) lower in patients with acute appendicitis than in patients without appendicitis.

Conclusions:

Both clinical findings and laboratory tests are unable to reliably distinguish between patients with acute appendicitis and those without. If both WBC count and CRP are normal, acute appendicitis is very unlikely. The current results emphasize the role of CT imaging in patients with suspected acute appendicitis.

Keywords: acute appendicitis; antibiotic treatment; clinical findings; computed tomography; conservative; laboratory findings
Corresponding author: Elina Lietzén, MD, The Division of Digestive Surgery and Urology, Department of Acute and Digestive Surgery, Turku University Central Hospital, Kiinamyllynkatu 4-8, 20520 Turku, Finland, Phone: +358 2313 5918, Fax: +358 2 261 2284

  1. Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

  2. Research funding: This study was supported by a Turku University Hospital Government Research Grant (TYKS EVO Foundation). Dr. Salminen has received personal fees for lectures from Merck and Roche.

  3. Employment or leadership: None declared.

  4. Honorarium: None declared.

  5. Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.

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Received: 2015-10-9
Accepted: 2016-2-15
Published Online: 2016-3-24
Published in Print: 2016-10-1

©2016 Walter de Gruyter GmbH, Berlin/Boston

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https://doi.org/10.1515/cclm-2015-0981
Keywords for this article
acute appendicitis; antibiotic treatment; clinical findings; computed tomography; conservative; laboratory findings

Articles in the same Issue

  1. Frontmatter
  2. Editorial
  3. Serum myoglobin immunoassays: obsolete or still clinically useful?
  4. Reviews
  5. Kounis syndrome: an update on epidemiology, pathogenesis, diagnosis and therapeutic management
  6. What do we know about homocysteine and exercise? A review from the literature
  7. Mini Review
  8. Osteocalcin as a potential risk biomarker for cardiovascular and metabolic diseases
  9. Opinion Paper
  10. Statistical approach for optimization of external quality assurance (EQA) studies of molecular and serological viral diagnostics
  11. EFLM Article
  12. Sample collections from healthy volunteers for biological variation estimates’ update: a new project undertaken by the Working Group on Biological Variation established by the European Federation of Clinical Chemistry and Laboratory Medicine
  13. General Clinical Chemistry and Laboratory Medicine
  14. Analyte stability during the total testing process: studies of vitamins A, D and E by LC-MS/MS
  15. Improvement in the predictive ability of the Intermountain Mortality Risk Score by adding routinely collected laboratory tests such as albumin, bilirubin, and white cell differential count
  16. Cystatin C provides a better estimate of the effect of glomerular filtration rate on serum human epididymis protein 4 concentrations
  17. Verification of the harmonization of human epididymis protein 4 assays
  18. Clinical utility of urinary liver-type fatty acid binding protein measured by latex-enhanced turbidimetric immunoassay in chronic kidney disease
  19. Comparison of three analytical platforms for quantification of the neurofilament light chain in blood samples: ELISA, electrochemiluminescence immunoassay and Simoa
  20. Reference Values and Biological Variations
  21. Distribution of antiphospholipid antibodies in a large population-based German cohort
  22. Cardiovascular Diseases
  23. Serum protein S100 as marker of postoperative delirium after off-pump coronary artery bypass surgery: secondary analysis of two prospective randomized controlled trials
  24. Infectious Diseases
  25. Copeptin predicts 10-year all-cause mortality in community patients: a 10-year prospective cohort study
  26. Clinical and laboratory findings in the diagnosis of right lower quadrant abdominal pain: outcome analysis of the APPAC trial
  27. Letters to the Editor
  28. Why a new algorithm using high-sensitivity cardiac troponins for the rapid rule-out of NSTEMI is not adapted to routine practice
  29. Optimal collection tubes for plasma glucose determination: confusion reigns supreme
  30. Long-term stability of serum samples positive for carbohydrate deficient transferrin (CDT) routinely stored at −20 °C
  31. Seasonal variations in plasma free metanephrine concentrations are not evident in the West of Ireland
  32. Potential errors in the determination of urinary ammonium by formol titration
  33. Interference by biological anti-cancer drugs in electrophoretic and immunofixation techniques
  34. A point mutation in the thiopurine S-methyltransferase gene that led to exon 5 deletion in the transcribed mRNA
  35. Detection of the heterozygote of hemoglobin Constant Spring by α-thalassemia immunochromatographic strip test
  36. Automated CH50 liposome-based immunoassay: consideration in dilution and validation of reference interval
  37. Theranos phenomenon – Part 5: Theranos’ presentation at the American Association for Clinical Chemistry Annual Conference 2016
  38. Congress Abstracts
  39. 58th National Congress of the Hungarian Society of Laboratory Medicine
  40. The 4th Joint EFLM-UEMS Congress “Laboratory Medicine at the Clinical Interface” Warsaw, Poland, 21th–24th September, 2016
  41. Congress of Clinical Chemistry and Laboratory Medicine
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