Appendicitis is the most common surgical emergency among children, but it can be difficult to diagnose because its main symptom - abdominal pain - is common to many other ailments. CT scans have helped clarify the picture somewhat, but up to 30 percent of appendectomies are still unnecessary, while in up to 45 percent of appendicitis cases, the appendix ruptures because the diagnosis is missed.
Researchers led by Dr. Alex Kentsis of Children’s Hospital Boston searched for substances in urine that could more accurately signal appendicitis. Using sophisticated screening tools, they analyzed levels of 57 substances in urine samples collected from 67 children, 25 of whom turned out to have appendicitis. One protein, called leucine-rich alpha-2-glycoprotein, was high both in appendicitis patients’ urine samples and in diseased appendix tissue. All but one appendicitis case was correctly identified based on LRG levels in a urine sample, but one patient’s kidney infection was mistakenly called appendicitis. In two appendicitis patients whose appendices appeared normal on their CT scans, LRG was elevated in their urine samples. The more LRG present in the urine, the more severe the appendicitis.
BOTTOM LINE: A protein found in the urine of children with appendicitis might lead to a better way to accurately diagnose the disease.
CAUTIONS: The scientists tested the biomarker as a sign of appendicitis only in children, so its value in testing adults is not known.
WHAT’S NEXT: Larger studies using simpler techniques such as urine dipsticks are needed to validate what the scientists found in their small study.
WHERE TO FIND IT: Annals of Emergency Medicine, online June 23
Moms RSS Feed