Predictive Role of Hematological Markers on Pediatric Appendicitis: Still a Mystery

Abstract

Aim: The diagnosis of appendicitis may be challenging in the pediatric population. It can be very difficult to examine a child or to take a medical history. The role of laboratory findings is still unclear. Therefore, we aimed to evaluate the diagnostic value of hematological parameters such as white blood cell, neutrophil to eosinophil ratio, and neutrophil to lymphocyte ratio. Material and Methods: We retrospectively analyzed patients who underwent surgery with suspected appendicitis between February 2018 and February 2020. Preoperative data were gathered from patient records. Histopathological assessment was accepted as the gold standard in the diagnosis of appendicitis. Results: The study population consists of 368 patients with a mean age of 11.95±3.68 years, 56.25% (n=207) of whom were male. The pathological examination revealed that 63.6% (n=234) of the patients were acute appendicitis, 18.5% (n=68) phlegmonous, and 8.7% (n=32) perforated. White blood cells, neutrophil-eosinophil ratio, and neutrophil-lymphocyte ratio were not diagnostic in acute appendicitis. On the other hand, the same parameters are useful markers in differentiating phlegmonous and perforated appendicitis. Conclusion: There is no established biomarker for acute appendicitis. Although the white blood cell count is a well-known parameter in scoring systems, it is not capable of guiding the surgeon. The neutrophil to eosinophil ratio may be a novel diagnostic index for phlegmonous and perforated appendicitis. Understanding whether a child is experiencing appendicitis is still a diagnostic challenge for the clinician. Although clinical symptoms, scoring systems, and imaging methods and laboratory tests are important in the diagnosis of appendicitis, there are not any specific markers helping the surgeon.