Int J Clin Pediatr

International Journal of Clinical Pediatrics, ISSN 1927-1255 print, 1927-1263 online, Open Access

Article copyright, the authors; Journal compilation copyright, Int J Clin Pediatr and Elmer Press Inc

Journal website http://www.theijcp.org

Original Article

Volume 1, Number 1, February 2012, pages 9-18

Clinical Significance of Fever and Leukocytosis in Diagnosis of Acute Appendicitis in Children Who Visit Emergency Department With Abdominal Pain

Figure 2. ROC points and fitted AUCs for the acute appendicitis. ROC points and fitted AUCs for fever for the acute appendicitis (A), ROC points and fitted AUCs for WBC count for the acute appendicitis (B), ROC points and fitted AUCs for segment neutrophil for the acute appendicitis (C).

Figure 3. ROC points and fitted AUCs for fever for the acute appendicitis. Study population with WBC count over 10,000/mm³ (A), Study population with WBC count under 10,000/mm³ (B), Study population with segment neutrophil over 75% (C), Study population with segment neutrophil under 75% (D), Study population with age range 1 - 3 years (E), Study population with age range 4 - 11 years (F), Study population with age range over 12 years (G). Among study population, acute appendicitis and mesenteric lymphadenitis (H).

**Table 1.** Comparison of Characteristics of Study Population
Characteristics	Appendicitis group (n = 119)	Non appendicitis group (n = 555)	P value
*: statistical significance was established at a level of P < 0.05.
Age (years)	11.5 ± 4.2	8.6 ± 5.3	< 0.001*
Toddler (1 - 3.9 years)	2 (1.7%)	125 (22.5%)	0.324
Child (4 - 11.9 years)	58 (48.7%)	238 (42.9%)	0.129
Adolescent (12 - 18 years)	59 (49.6%)	192 (34.6%)	0.210
Male sex (%)	59.7%	53.7%	0.235
Initial temperature (°C, axillary)	36.8 ± 0.6	36.6 ± 0.7	0.188
WBC count (×1000/mm³)	14.8 ± 4.8	9.7 ± 4.1	< 0.001*
Segment neutrophil (%)	78.6 ± 12.4	64.4 ± 16.4	< 0.001*

Table 1. Comparison of Characteristics of Study Population

Characteristics

Appendicitis group (n = 119)

Non appendicitis group (n = 555)

P value

*: statistical significance was established at a level of P < 0.05.

Age (years)

11.5 ± 4.2

8.6 ± 5.3

< 0.001*

Toddler (1 - 3.9 years)

2 (1.7%)

125 (22.5%)

0.324

Child (4 - 11.9 years)

58 (48.7%)

238 (42.9%)

0.129

Adolescent (12 - 18 years)

59 (49.6%)

192 (34.6%)

0.210

Male sex (%)

59.7%

53.7%

0.235

Initial temperature (°C, axillary)

36.8 ± 0.6

36.6 ± 0.7

0.188

WBC count (×1000/mm³)

14.8 ± 4.8

9.7 ± 4.1

< 0.001*

Segment neutrophil (%)

78.6 ± 12.4

64.4 ± 16.4

< 0.001*

**Table 2.** Comparison of Fever and White Blood Cell Between Appendicitis and Non-Appendicitis Stratified by Age
Characteristics	Group	Age group
*: statistical significance was established at a level of P < 0.05.
Elevation in temperature (≥ 37.4 °C)	Appendicitis	0/2 (0%)	11/58 (19%)	3/59 (5.1%)	14/119 (11.8%)
	Non appendicitis	27/125 (21.6%)	35/238 (14.7%)	14/192 (7.3%)	76/555 (13.7%)
	P value	1.000	0.422	0.769	0.575
Leukocytosis (≥ 10,000/mm³)	Appendicitis	1/2 (50.1%)	53/58 (91.4%)	49/59 (83.1%)	103/119 (86.6%)
	Non appendicitis	29/51 (56.9%)	57/170 (33.5%)	63/177 (35.6%)	149/398 (37.4%)
	P value	1.000	< 0.001*	< 0.001*	< 0.001*
Shift of WBC to the left (> 75%)	Appendicitis	1/2 (50.0%)	43/58 (74.1%)	47/59 (79.7%)	91/119 (76.5%)
	Non appendicitis	15/51 (29.4%)	62/170 (36.5%)	56/177 (31.6%)	133/398 (33.4%)
	P value	0.517	< 0.001*	< 0.001*	< 0.001*

Table 2. Comparison of Fever and White Blood Cell Between Appendicitis and Non-Appendicitis Stratified by Age

Characteristics

Group

Age group

Toddler (1 - 3.9 years)

Child (4 - 11.9years)

Adolescent (12 - 18 years)

total

*: statistical significance was established at a level of P < 0.05.

Elevation in temperature (≥ 37.4 °C)

Appendicitis

0/2 (0%)

11/58 (19%)

3/59 (5.1%)

14/119 (11.8%)

Non appendicitis

27/125 (21.6%)

35/238 (14.7%)

14/192 (7.3%)

76/555 (13.7%)

P value

1.000

0.422

0.769

0.575

Leukocytosis (≥ 10,000/mm³)

Appendicitis

1/2 (50.1%)

53/58 (91.4%)

49/59 (83.1%)

103/119 (86.6%)

Non appendicitis

29/51 (56.9%)

57/170 (33.5%)

63/177 (35.6%)

149/398 (37.4%)

P value

1.000

< 0.001*

Shift of WBC to the left (> 75%)

Appendicitis

1/2 (50.0%)

43/58 (74.1%)

47/59 (79.7%)

91/119 (76.5%)

Non appendicitis

15/51 (29.4%)

62/170 (36.5%)

56/177 (31.6%)

133/398 (33.4%)

P value

0.517

< 0.001*

**Table 3.** Comparison of Characteristics of Non-Appendicitis Group
Characteristics	AGE group (n = 220)	Fecal impaction group (n = 155)	Mesenteric lymphadenitis group (n = 108)	Other group (n = 72)	P-value
*: statistical significance was established at a level of P < 0.05.
Age, years	9.5 ± 5.5	6.3 ± 4.4	10.0 ± 4.2	8.5 ± 6.3	< 0.001*
Male sex	50.0%	52.3%	62.0%	53.7%	0.445
Initial temperature (°C, axillary)	36.7 ± 0.7	36.6 ± 0.6	36.7 ± 0.7	36.7 ± 0.7	0.118
WBC count (×1000/mm³)	9.7 ± 3.9	8.8 ± 3.1	9.6 ± 4.3	11.0 ± 5.0	< 0.001*
Segment neutrophil (%)	65.1 ± 15.8	59.9 ± 15.5	64.4 ± 17.4	67.7 ± 16.6	< 0.001*

Table 3. Comparison of Characteristics of Non-Appendicitis Group

Characteristics

AGE group (n = 220)

Fecal impaction group (n = 155)

Mesenteric lymphadenitis group (n = 108)

Other group (n = 72)

P-value

*: statistical significance was established at a level of P < 0.05.

Age, years

9.5 ± 5.5

6.3 ± 4.4

10.0 ± 4.2

8.5 ± 6.3

< 0.001*

Male sex

50.0%

52.3%

62.0%

53.7%

0.445

Initial temperature (°C, axillary)

36.7 ± 0.7

36.6 ± 0.6

36.7 ± 0.7

0.118

WBC count
(×1000/mm³)

9.7 ± 3.9

8.8 ± 3.1

9.6 ± 4.3

11.0 ± 5.0

< 0.001*

Segment neutrophil (%)

65.1 ± 15.8

59.9 ± 15.5

64.4 ± 17.4

67.7 ± 16.6

< 0.001*