Clinical Accuracy of Inflammatory Markers Combined with Ultrasound in Acute Appendicitis

Abstract

Objective: To determine the clinical accuracy of inflammatory markers combined with ultrasound, in acute appendicitis keeping histopathology as gold standard.Study design: Cross Sectional (validation) study.Study setting: Surgical B ward, Department of Surgery Khyber teaching hospital Peshawar.Duration of Study: 07 months i.e from 1st September 2014 to 31st of Mar, 2015Methodology: All patients having acute appendicitis were subjected to blood sampling for CRP, TLC and neutrophil%. After that all these patients were subjected to ultrasonography to detect the presence or absence of appendicitis. All removed appendices were sent for histopathology which was taken as the gold standard.Results In the present study, TLC had the highest sensitivity (77.68%) followed by neutrophil% (69.96%), CRP (67.10%) and U/Sound (62.96%) respectively. While U/Sound had the highest specificity (70.59%) followed by CRP and TLC (64.71% each) and neutrophil% (58.82%) respectively. When all the four tests were combined   the sensitivity, specificity, (99.17% and 98.45%) increased significantly. It was seen that when all the four tests were negative, appendicitis could be safely ruled out and surgery could be deferred in these patients.It would reduce the rate of negative appendicectomies.Conclusion: TLC  contains  important  diagnostic   information  and  hence  should  always  be included in  the diagnostic  workup of  acute appendicitis.  The sensitivity of   CRP and Neut. % is low individually, but when combined with TLC and u/sound the sensitivity and specificity increases significantly. But it is stressed that history and clinical examination by a skilled surgeon still remain important in diagnosing acute appendicitis, and its importance cannot be denied. The investigations can be used as an adjuvant to a surgeon’s clinical diagnosis