Diagnostic accuracy of blood tests of inflammation in paediatric appendicitis: a systematic review and meta-analysis
Objective Possible childhood appendicitis is a common emergency presentation. The exact value of blood tests is debated. This study sought to determine the diagnostic accuracy of four blood tests (white cell count (WCC), neutrophil(count or percentage), C reactive protein (CRP) and/or procalcitonin)...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2022-11-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/12/11/e056854.full |
| _version_ | 1828315370456350720 |
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| author | José M Ordóñez-Mena Ann Van den Bruel Gail Hayward Gea A Holtman David Fawkner-Corbett Mohammed Alkhmees |
| author_facet | José M Ordóñez-Mena Ann Van den Bruel Gail Hayward Gea A Holtman David Fawkner-Corbett Mohammed Alkhmees |
| author_sort | José M Ordóñez-Mena |
| collection | DOAJ |
| description | Objective Possible childhood appendicitis is a common emergency presentation. The exact value of blood tests is debated. This study sought to determine the diagnostic accuracy of four blood tests (white cell count (WCC), neutrophil(count or percentage), C reactive protein (CRP) and/or procalcitonin) for childhood appendicitis.Design A systematic review and diagnostic meta-analysis. Data sources included MEDLINE, EMBASE, Central, Web of Science searched from inception-March 2022 with reference searching and authors contacted for missing/unclear data. Eligibility criteria was studies reporting the diagnostic accuracy of the four blood tests compared to the reference standard (histology or follow-up). Risk of bias was assessed (QUADAS-2), pooled sensitivity and specificity were generated for each test and commonly presented cut-offs. To provide insight into clinical impact, we present strategies using a hypothetical cohort.Results 67 studies were included (34 839 children, 13 342 with appendicitis), all in the hospital setting. The most sensitive tests were WCC (≥10 000 cells/µL, 53 studies sensitivity 0.85 (95% CI 0.80 to 0.89)) and absolute neutrophil count (ANC) (≥7500 cells/µL, five studies sensitivity 0.90 (95% CI 0.85 to 0.94)). Combination of WCC or CRP increased sensitivity further(≥10 000 cells/µL or ≥10 mg/L, individual patient data (IPD) of 6 studies, 0.97 (95% CI 0.93 to 0.99)).Applying results to a hypothetical cohort(1000 children with appendicitis symptoms, of whom 400 have appendicitis) 60 and 40 children would be wrongly discharged based solely on WCC and ANC, respectively, 12 with combination of WCC or CRP.The most specific tests were CRP alone (≥50 mg/L, 38 studies, specificity 0.87 (95% CI 0.80 to 0.91)) or combined with WCC (≥10 000 cells/µL and ≥50 mg/L, IPD of six studies, 0.93 (95% CI 0.91 to 0.95)).Conclusions The best performing single blood tests for ruling-out paediatric appendicitis are WCC or ANC; with accuracy improved combining WCC and CRP. These tests could be used at the point of care in combination with clinical prediction rules. We provide insight into the best cut-offs for clinical application.PROSPERO registration number CRD42017080036 |
| first_indexed | 2024-04-13T16:59:03Z |
| format | Article |
| id | doaj.art-e40d676a4904442b9a791a281ea17b0f |
| institution | Directory Open Access Journal |
| issn | 2044-6055 |
| language | English |
| last_indexed | 2024-04-13T16:59:03Z |
| publishDate | 2022-11-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj.art-e40d676a4904442b9a791a281ea17b0f2022-12-22T02:38:43ZengBMJ Publishing GroupBMJ Open2044-60552022-11-01121110.1136/bmjopen-2021-056854Diagnostic accuracy of blood tests of inflammation in paediatric appendicitis: a systematic review and meta-analysisJosé M Ordóñez-Mena0Ann Van den Bruel1Gail Hayward2Gea A Holtman3David Fawkner-Corbett4Mohammed Alkhmees51 NIHR Community Healthcare MedTech and IVD Co-operative, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK5 EPI-Centre, Academic Centre for Primary Care, Department of Public Health and Primary Care, KU Leuven, 3000 Leuven, Belgium1 NIHR Community Healthcare MedTech and IVD Co-operative, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK1 NIHR Community Healthcare MedTech and IVD Co-operative, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK1 NIHR Community Healthcare MedTech and IVD Co-operative, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK4 Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The NetherlandsObjective Possible childhood appendicitis is a common emergency presentation. The exact value of blood tests is debated. This study sought to determine the diagnostic accuracy of four blood tests (white cell count (WCC), neutrophil(count or percentage), C reactive protein (CRP) and/or procalcitonin) for childhood appendicitis.Design A systematic review and diagnostic meta-analysis. Data sources included MEDLINE, EMBASE, Central, Web of Science searched from inception-March 2022 with reference searching and authors contacted for missing/unclear data. Eligibility criteria was studies reporting the diagnostic accuracy of the four blood tests compared to the reference standard (histology or follow-up). Risk of bias was assessed (QUADAS-2), pooled sensitivity and specificity were generated for each test and commonly presented cut-offs. To provide insight into clinical impact, we present strategies using a hypothetical cohort.Results 67 studies were included (34 839 children, 13 342 with appendicitis), all in the hospital setting. The most sensitive tests were WCC (≥10 000 cells/µL, 53 studies sensitivity 0.85 (95% CI 0.80 to 0.89)) and absolute neutrophil count (ANC) (≥7500 cells/µL, five studies sensitivity 0.90 (95% CI 0.85 to 0.94)). Combination of WCC or CRP increased sensitivity further(≥10 000 cells/µL or ≥10 mg/L, individual patient data (IPD) of 6 studies, 0.97 (95% CI 0.93 to 0.99)).Applying results to a hypothetical cohort(1000 children with appendicitis symptoms, of whom 400 have appendicitis) 60 and 40 children would be wrongly discharged based solely on WCC and ANC, respectively, 12 with combination of WCC or CRP.The most specific tests were CRP alone (≥50 mg/L, 38 studies, specificity 0.87 (95% CI 0.80 to 0.91)) or combined with WCC (≥10 000 cells/µL and ≥50 mg/L, IPD of six studies, 0.93 (95% CI 0.91 to 0.95)).Conclusions The best performing single blood tests for ruling-out paediatric appendicitis are WCC or ANC; with accuracy improved combining WCC and CRP. These tests could be used at the point of care in combination with clinical prediction rules. We provide insight into the best cut-offs for clinical application.PROSPERO registration number CRD42017080036https://bmjopen.bmj.com/content/12/11/e056854.full |
| spellingShingle | José M Ordóñez-Mena Ann Van den Bruel Gail Hayward Gea A Holtman David Fawkner-Corbett Mohammed Alkhmees Diagnostic accuracy of blood tests of inflammation in paediatric appendicitis: a systematic review and meta-analysis BMJ Open |
| title | Diagnostic accuracy of blood tests of inflammation in paediatric appendicitis: a systematic review and meta-analysis |
| title_full | Diagnostic accuracy of blood tests of inflammation in paediatric appendicitis: a systematic review and meta-analysis |
| title_fullStr | Diagnostic accuracy of blood tests of inflammation in paediatric appendicitis: a systematic review and meta-analysis |
| title_full_unstemmed | Diagnostic accuracy of blood tests of inflammation in paediatric appendicitis: a systematic review and meta-analysis |
| title_short | Diagnostic accuracy of blood tests of inflammation in paediatric appendicitis: a systematic review and meta-analysis |
| title_sort | diagnostic accuracy of blood tests of inflammation in paediatric appendicitis a systematic review and meta analysis |
| url | https://bmjopen.bmj.com/content/12/11/e056854.full |
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