Usefulness of laboratory data in the management of right iliac fossa pain in adults

Abstract

Purpose: This study examined the usefulness of inflammatory markers in the management of patients with right iliac fossa pain.

Patients and methods: A single site, prospective observational study was conducted from October 2001 to April 2003. Patients with right iliac fossa pain referred to the surgeon were included. Blood samples were obtained for C-reactive protein, leukocyte, and granulocyte analysis. Clinical, surgical, and histopathologic data were collected. Analysis of inflammatory parameters was performed with logistic regression and areas under the receiver operating characteristic curve were compared.

Results: C-reactive protein increased with the severity of appendicitis and predicted accurately perforation (r(2) = 0.613; P < 0.0005), showing the highest accuracy among inflammatory markers (areas under the receiver operating characteristics curve were 0.846, 0.753, and 0.685 for C-reactive protein, leukocyte and granulocytes, respectively; P < 0.001). Accuracy improved when C-reactive protein and leukocytes were combined; positive and negative predictive values were 93.2 percent and 92.3 percent, respectively.

Conclusions: C-reactive protein is a helpful marker in the management of patients with right iliac fossa pain; the predictive value improves when combined with leukocyte count. A patient with normal C-reactive protein and leukocytes has a very low probability of appendicitis and should not undergo surgery.

Figure 1

Distribution of C-reactive protein (CRP) (1.a), white blood-cell count (1.b) and percentage of granulocytes (1.c) following the severity of appendicitis.

Figure 1

Distribution of C-reactive protein (CRP) (1.a), white blood-cell count (1.b) and percentage of granulocytes (1.c) following the severity of appendicitis.