Published online January 2, 2008
PEDIATRICS Vol. 121 Supplement January 2008, pp. S164 (doi:10.1542/peds.2007-2022QQQQQQQ)
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SURGERY


PROCALCITONIN AS A PREDICTOR OF SEVERE APPENDICITIS IN CHILDREN

Ioanna Velissarioua, Dimitris Kafetzisa, Pantelis Nikolaidesb, Michael Sklavosb, Maher Maktabib, George Spyridisb, Despoina Kafetzisa and Emmanuel Androulakakisb

a Second Department of Pediatrics
b First Department of Surgery, Panagiotis and Aglaia Kyriakou Children's Hospital, Athens, Greece

ABSTRACT

INTRODUCTION: Procalcitonin is an amino acid peptide that can contribute in the diagnosis and management of severe bacterial infections because it reaches high concentrations in patients with severe bacterial infection, septicemia, or meningitis and decreases rapidly after appropriate antibiotic therapy.

OBJECTIVE: The objective of this study was to assess the diagnostic value of procalcitonin in 212 children with appendicitis and compare it with the standard diagnostic modalities, C-reactive protein, white blood cell count, and abdominal ultrasonography, in relation to the surgical and histologic findings of the appendix.

METHODS: Prolactin levels were measured in 212 children with appendicitis, and the results were compared with standard diagnostic modalities such as C-reactive protein level, white blood cell count, and abdominal ultrasonography, which are useful aids for detecting severe appendicitis and/or perforation.

RESULTS: A procalcitonin value of >0.5 ng/mL was indicative of perforation or gangrene with 73.4% sensitivity and 94.6% specificity, C-reactive protein level of >50 mg/L and white blood cell count of >104/µL are useful diagnostic aids for perforation, and abdominal ultrasonography had a sensitivity of 82.8% and a specificity of 91.2%.

CONCLUSIONS: Procalcitonin seems to be a useful adjunct diagnostic tool for acute necrotizing appendicitis or perforation, and surgical exploration will probably be required in patients with procalcitonin values of >0.5 ng/mL.

Submitted by Ioanna Velissariou