The Significance of Combined Detection of Ultrasonography, Pediatric Appendicitis Score and C-reactive Protein in the Diagnosis and Pathological type of Acute Appendicitis in Children

Abstract Background : As one of the most common diseases of acute abdomen, early diagnosis of acute appendicitis remains a vital issue. This study aims to explore the value of combined ultrasonography, Pediatric Appendicitis Score and C-reactive protein in the diagnosis and pathological types of appendicitis in children. Method : A total of 268 children with acute abdominal pain admitted to our center between January 2017 and January 2020 were retrospectively analyzed and divided into group acute appendicitis and group non-acute appendicitis based on the surgical findings and pathological findings. Group acute appendicitis was further divided into three groups based on the types of pathology, group simple appendicitis, group suppurative appendicitis and group gangrenous appendicitis. Results : Pediatric Appendicitis Score and level of C-reactive protein in group acute appendicitis were higher than group non-acute appendicitis ( P < 0.05). The areas under the receiver operating characteristic curve of Pediatric Appendicitis Score, C-reactive protein and ultrasonography for acute appendicitis were 0.871, 0.777 and 0.897, respectively ( P < 0.001). The sensitivity and negative predictive value of ultrasonography combined with Pediatric Appendicitis Score and C-reactive protein in diagnosing acute appendicitis were higher than ultrasonography and CRP, while the specificity and positive predictive value were lower ( P ＜0.05). The C-reactive protein in the acute complicated appendicitis was significantly higher than simple appendicitis, and the areas under the ROC curve of C-reactive protein and ultrasonography in diagnosing acute complicated appendicitis were 0.814(0.762-0.867) and 0.861(0.812-0.909). The sensitivity of ultrasonography combined with C-reactive protein in diagnosing acute complicated appendicitis was 98.21%, which was significantly higher than that of ultrasonography and CRP alone ( P ＜0.05). The sensibilities of ultrasonography for different pathological types of appendicitis were 78.95% for acute simple appendicitis, 81.97% for acute suppurative appendicitis and 92.16% for acute gangrenous appendicitis. The diagnostic results of ultrasonography for different pathological types of appendicitis in children were consistent with those of pathological examination (Kappa=0.888; P < 0.001). Conclusion : The combination of ultrasonography, Pediatric Appendicitis Score and C-reactive protein detection is helpful to the accurate diagnosis of acute appendicitis, and ultrasonography combined with CRP may contribute to diagnosing pathological type of appendicitis in children, providing important evidence for clinical diagnosis.