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Likelihood Ratio (LR) in Emergency Medicine

10/04/2012

Does procalcitonin have a role in the management of acute appendicitis?


Clinical scenario
A 18 yo man comes to the ED in the morning because of low abdominal pain, fever and nausea. At palpation there is mild pain in the right inferior quadrant, not guarding.




Could procalcitonin (PTC) helps to exclude quickly an acute appendicitis?







Conclusion


The figures are clear. We cannot use the PCT to rule out an acute appendicitis, but it could be useful  to identify patients that may have complicated appendicitis.
In previous post we have pointed out the poor utility of signs and symptoms alone to screen patients with or without an acute appendicitis.
Its the same for laboratory tests.  


Bibliography


M. Sand
A prospective bicenter study investigating the diagnostic value of procalcitonin in patients with acute appendicitis.
Eur Surg Res 2009; 43 291-297

JY Wu
Diagnostic role of procalcitonin in patients with suspected appendicitis.
World J Surg 2012 Aug 36 (8) 1744-1749


                                                                                                           Ciro Paolillo



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