Nikkels, E.D. (2019) The diagnostic value of C-reactive protein for appendicitis in children presenting with acute abdominal pain in primary care. thesis, Medicine.
Full text available on request.Abstract
Abstract Introduction Acute abdominal pain is a common symptom of a child presenting in primary care. Appendicitis is one of the differential diagnoses of acute abdominal pain and a challenge for the general practitioner to interpret accurately. A potential tool in the diagnostics of appendicitis in primary care is the C-Reactive Protein (CRP)-test. The diagnostic value of the CRP-test is however, in these patients, still undetermined. Insight in the diagnostic value could improve the use and interpretation of the CRP-test in primary care and could help general practitioners to diagnose appendicitis and prevent unnecessary referral. Methods In this retrospective cohort study we selected medical records of children, age 4 to 18, with abdominal pain of maximum 7 days who underwent a CRP-test in primary care. The primary outcome was appendicitis. This was proven when it was official registered as diagnosis with an IPCI-code or by letter from a medical specialist. The diagnostic value of CRP was calculated by defining the sensitivity, specificity, positive likelihood ratio (LH+), negative likelihood ratio (LH-) and Area Under the receiver operating Curve (AUC). Results In total 1076 children were included, of which 67 children (6.2%) with appendicitis. The median level of CRP increased from 5 mg/l in the non-appendicitis group, to 41 mg/l in children with appendicitis and up to 101 mg/l in children with a perforated appendicitis. The sensitivity of the CRP-test was 86.6% at the lowest cut-off point of ≥10 mg/l and had a LH- of 0.18. The diagnostic value of CRP increased to a sensitivity of 97.5% with a LH- of 0.03 in patients with abdominal pain longer than 24 hours. The diagnostic value of the CRP-test was highest in patients with a perforated appendicitis (AUC: 0.965) and had a LH- of 0.07 below the cut-off point of 50 mg/l. Conclusion The CRP-test can be used as a tool to rule-out appendicitis in selected children who present with acute abdominal pain in primary care. Appendicitis could be ruled-out (LH- <0.1) in patients with over 24 hours of symptoms and a CRP-level below 10mg/l and a perforated appendicitis could be ruled-out in all patients below 50 mg/l.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Holtman, Dr. G.A. and Blok, Drs. C.G.H. and Berger, Prof. Dr. M.Y. and Department of General Practice and University Medical Center Groningen |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:40 |
| Last Modified: | 25 Jun 2020 10:40 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/202 |
Actions (login required)
 |
View Item |