DIAGNOSTIC ROLE OF C-REACTIVE PROTEIN (CRP) IN ACUTE APPENDICITIS – A DOUBLE BLIND STUDY
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Keywords
C-reactive protein, CRP, negative appendicectomy, acute appendicitis, HPE- Histopathological co-relation
Abstract
Background: Acute appendicitis is one of the most common causes of right iliac fossa pain and the most common surgical emergencies. Appendicectomy is the most commonly performed emergency surgery, still its diagnosis remains a challenge, with high rate of negative appendicectomy performed every year.
Objective: The objective of the study was to evaluate the role of accuracy of serum CRP estimation in the diagnosis of acute appendicitis and to reduce the morbidity by avoiding negative appendicectomy.
Methods: The study was conducted in Venkateshwara Institute of Medical Science, Gajraula, Uttar Pradesh. The study included 100 patients who were clinically diagnosed in emergency by a general surgeon as having acute appendicitis and posted for emergency appendicectomy. Preoperatively serum CRP estimation was done, and after the surgical intervention, all specimens were subjected to Histopathological Examination (HPE). Results of preoperative serum CRP level and postoperative HPE reports were corelated to evaluate the role of CRP in diagnosis of acute appendicitis.
Results: In present study, CRP has sensitivity and specificity of 91.8% and 86.7% respectively with positive predictive value of 97.5%. Hence it proves that CRP estimation can be used as a diagnostic tool to rule out appendicitis, so that surgery can be deferred in those subjects and can finally help to reduce rate of negative appendicectomies.
Conclusion: It is evident that history and clinical examination by a skilled surgeon still remain mainstay in diagnosing acute appendicitis. CRP being a cheap and easy diagnostic test should be included in the work up of acute appendicitis to lower negative appendicectomy rate.
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Dr Anand Kishore
Assistant Professor, Department of General Surgery, VIMS, Gajraula (UP).
Dr Sourav Panda
Junior Resident, Department of General Surgery, Max Super-Speciality Hospital, Saket, New Delhi.