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Different urinalysis appearances in children with simple and perforated appendicitis

  • Author Footnotes
    1 Chun-Yu Chen and Lu-Lu Zhao contributed equally to this work.
    Chun-Yu Chen
    Footnotes
    1 Chun-Yu Chen and Lu-Lu Zhao contributed equally to this work.
    Affiliations
    Department of Pediatrics, Changhua Christian Hospital, Changhua, Taiwan, ROC

    School of Medicine, Chung Shan Medical University, Taichung, Taiwan, ROC
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  • Author Footnotes
    1 Chun-Yu Chen and Lu-Lu Zhao contributed equally to this work.
    Lu-Lu Zhao
    Footnotes
    1 Chun-Yu Chen and Lu-Lu Zhao contributed equally to this work.
    Affiliations
    Department of Pediatrics, Taipei Tzuchi Hospital, the Buddhist Medical Foundation, Taipei, Taiwan, ROC
    Search for articles by this author
  • Yan-Ren Lin
    Affiliations
    School of Medicine, Chung Shan Medical University, Taichung, Taiwan, ROC

    Department of Emergency Medicine, Changhua Christian Hospital, Changhua, Taiwan, ROC

    Department of Biological Science and Technology and Institute of Biochemical Engineering, National Chiao Tung University, Hsinchu, Taiwan, ROC
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  • Kang-Hsi Wu
    Affiliations
    Department of Pediatrics, Children's Hospital and School of Chinese Medicine, China Medical University Hospitals, Taichung, Taiwan, ROC
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  • Han-Ping Wu
    Correspondence
    Corresponding author. Department of Pediatrics, Buddhist Tzu-Chi General Hospital, Taichung Branch, Taichung 42743, Taiwan ROC. Tel.: +886 4 3606 0666x3117; fax: +886 4 3602 1123.
    Affiliations
    Department of Pediatrics, Taichung Tzuchi Hospital, the Buddhist Medical Foundation, Taichung, Taiwan, ROC

    Department of Medicine, School of Medicine, Tzu-Chi University, Hualien, Taiwan, ROC
    Search for articles by this author
  • Author Footnotes
    1 Chun-Yu Chen and Lu-Lu Zhao contributed equally to this work.
Published:September 23, 2013DOI:https://doi.org/10.1016/j.ajem.2013.06.027

      Abstract

      Purpose

      This study aimed to determine whether routine urinalysis may serve as a tool in discriminating between acute appendicitis and perforated appendicitis in children.

      Basic procedures

      We prospectively collected 357 patients with clinically suspected acute appendicitis. Urinalysis was performed in patients with clinically suspected acute appendicitis before surgical intervention. Routine urinalysis is composed of 2 examinations: chemical tests for abnormal chemical constituents and microscopic tests for abnormal insoluble constituents. Receiver operating characteristic curves for urine white blood cell (WBC) counts and urine red blood cell (RBC) counts in distinguishing between patients with simple appendicitis and patients with perforated appendicitis were also analyzed.

      Main findings

      Urine ketone bodies, leukocyte esterase, specific gravity, pH, WBC, and RBC counts were all significant parameters among patients with normal appendices, simple appendicitis, and perforated appendicitis (all P < .05). Based on multivariate logistic regression analysis, positive urine ketone bodies and nitrate were significant parameters in predicting perforated appendicitis (P = .002 and P = .008, respectively). According to the results of receiver operating characteristic curves, the appropriate cutoff values were 2.0/high-power field for urine RBC counts and 4.0/high-power field for urine WBC counts in predicting perforated appendicitis in children.

      Principal conclusions

      Routine urinalysis may serve to aid in discriminating between simple and perforated appendicitis. Clinically, we believe that these urine parameters may aid primary emergency physicians with decision making in patients with clinically suspected appendicitis.
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