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

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.

• Authors: William Bonadio, Santina Bruno, David Attaway, Logesh Dharmar, Derek Tam, Peter Homel
• Journal: The American journal of emergency medicine (Am J Emerg Med) Vol. 35 Issue 6 Pg. 885-888 (Jun 2017) ISSN: 1532-8171 [Electronic] United States
• PMID: 28185747 (Publication Type: Journal Article)
• Copyright: Copyright © 2017 Elsevier Inc. All rights reserved.

Chemical References

• Bilirubin

Topics

• Abdominal Abscess (blood, diagnosis)
• Adolescent
• Appendicitis (blood, diagnosis)
• Bilirubin (blood)
• Child
• Child, Preschool
• Diagnosis, Differential
• Female
• Humans
• Hyperbilirubinemia (epidemiology)
• Male
• Predictive Value of Tests
• ROC Curve
• Retrospective Studies
• Tomography, X-Ray Computed
• United States