Eur J Trauma Emerg Surg DOI 10.1007/s00068-015-0540-x
ORIGINAL ARTICLE
Hyperbilirubinaemia in appendicitis: the diagnostic value for prediction of appendicitis and appendiceal perforation H. L. Adams1 · S. S. Jaunoo1
Received: 22 February 2015 / Accepted: 11 May 2015 © Springer-Verlag Berlin Heidelberg 2015
Abstract Aim The aim of this study is to evaluate the diagnostic value of pre-operative bilirubin levels in the diagnosis of acute appendicitis and appendiceal perforation. Method A retrospective analysis of 557 patients undergoing emergency appendicectomy over a 24-month period at a large teaching hospital. Hyperbilirubinaemia was defined as >25 µmol/L. Data were analysed using descriptive statistics. Results 484 of the 557 (86.9 %) operated cases were found histologically to be appendicitis. 116 cases of the 484 were perforated (24 %). Bilirubin levels were significantly higher in the group with appendicitis versus the group found to have a normal appendix at histology, [median (IQR) 12.0 µmol/L (9.00) vs. 8.0 µmol/L (7.00) respectively, p 25 µmol/L. Continuous data are presented as median (IQR) unless indicated otherwise. Differences in qualitative variables were assessed using Fisher’s exact test and quantitative variables were analysed using an unpaired T test. Relative risk was described by the estimated odds ratio (OR) with 95 % confidence interval. Two-sided p values were computed and p ≤ 0.05 was considered statistically significant. All statistical analyses were performed using GraphPad Prism® software (GraphPad Software, Inc, San Diego, CA 92130 USA).
Results 557 emergency appendicectomies were eligible for inclusion in this data set. Median age of patients undergoing appendicectomy was 24 years of age with a range of 6–86 years, 303 were male and 254 female (Table 1). A laparoscopic approach was used in 154 cases and laparoscopic converted to open procedure in seven patients (the latter have been treated as OA). A histological diagnosis of appendicitis was found in 413 patients (74.1 %), other histological diagnoses included normal appendix, benign hyperplastic polyp, carcinoid tumour and mucinous neoplasm. 276 patients had simple appendicitis and 137 had complicated appendicitis i.e. gangrenous n = 39 and perforated n = 98 (Fig. 1). Serum bilirubin, despite being within its normal range was significantly higher in cases of appendicitis compared with cases demonstrating a histologically normal appendix [median (IQR) 12.0 µmol/L (9.00) vs. 8.0 µmol/L (7.00), respectively, p
ORIGINAL ARTICLE
Hyperbilirubinaemia in appendicitis: the diagnostic value for prediction of appendicitis and appendiceal perforation H. L. Adams1 · S. S. Jaunoo1
Received: 22 February 2015 / Accepted: 11 May 2015 © Springer-Verlag Berlin Heidelberg 2015
Abstract Aim The aim of this study is to evaluate the diagnostic value of pre-operative bilirubin levels in the diagnosis of acute appendicitis and appendiceal perforation. Method A retrospective analysis of 557 patients undergoing emergency appendicectomy over a 24-month period at a large teaching hospital. Hyperbilirubinaemia was defined as >25 µmol/L. Data were analysed using descriptive statistics. Results 484 of the 557 (86.9 %) operated cases were found histologically to be appendicitis. 116 cases of the 484 were perforated (24 %). Bilirubin levels were significantly higher in the group with appendicitis versus the group found to have a normal appendix at histology, [median (IQR) 12.0 µmol/L (9.00) vs. 8.0 µmol/L (7.00) respectively, p 25 µmol/L. Continuous data are presented as median (IQR) unless indicated otherwise. Differences in qualitative variables were assessed using Fisher’s exact test and quantitative variables were analysed using an unpaired T test. Relative risk was described by the estimated odds ratio (OR) with 95 % confidence interval. Two-sided p values were computed and p ≤ 0.05 was considered statistically significant. All statistical analyses were performed using GraphPad Prism® software (GraphPad Software, Inc, San Diego, CA 92130 USA).
Results 557 emergency appendicectomies were eligible for inclusion in this data set. Median age of patients undergoing appendicectomy was 24 years of age with a range of 6–86 years, 303 were male and 254 female (Table 1). A laparoscopic approach was used in 154 cases and laparoscopic converted to open procedure in seven patients (the latter have been treated as OA). A histological diagnosis of appendicitis was found in 413 patients (74.1 %), other histological diagnoses included normal appendix, benign hyperplastic polyp, carcinoid tumour and mucinous neoplasm. 276 patients had simple appendicitis and 137 had complicated appendicitis i.e. gangrenous n = 39 and perforated n = 98 (Fig. 1). Serum bilirubin, despite being within its normal range was significantly higher in cases of appendicitis compared with cases demonstrating a histologically normal appendix [median (IQR) 12.0 µmol/L (9.00) vs. 8.0 µmol/L (7.00), respectively, p
