Researchers link a chemical in children’s urine to appendicitis. Emergency rooms could test for it, preventing unnecessary surgery and increasing the chance of removing the appendix before it bursts.
By Thomas H. Maugh II
Researchers have identified a chemical in urine that is closely associated with appendicitis in children and are working to develop a simple test that could be used to diagnose the condition — a test that would both increase the likelihood of performing surgery before the appendix bursts and prevent unnecessary surgery.
Preliminary results show that the test is highly accurate, producing very few instances in which cases are missed (false negatives) or children are incorrectly diagnosed with the condition (false positives), a team from Children’s Hospital Boston reported today in the Annals of Emergency Medicine.
Appendicitis is the most common childhood surgical emergency. The lifetime prevalence of appendicitis is 9% for males and 7% for females, but the bulk of the cases occur in childhood or adolescence. In the past, diagnosis was made simply from clinical symptoms, such as abdominal pain, and as many as 30% of cases in which surgery was performed revealed a healthy appendix.
Within the last few years, emergency room specialists have begun using CT scans for diagnosis, which reduces the number of unnecessary surgeries to as low as 5%. But in as many as 30% to 45% of those diagnosed with appendicitis, the organ has already ruptured at the time of surgery, leading to a variety of complications that lengthen hospital stays.
There has also been a growing reluctance to use CT scanners on children because of the risk that the radiation will trigger cancer later in life.
Dr. Richard Bachur and his colleagues studied urine from healthy children and those with surgically confirmed appendicitis, and concluded that high levels of one chemical, leucine-rich alpha-2-glycoprotein or LRG, correlated very closely with an inflamed appendix. Tests in 67 children showed that the amount in the urine was correlated to the severity of the inflammation, and the number of false positives and false negatives associated with its use were each less than 3%.
The team is now studying a larger number of urine samples and is working "feverishly" to develop a simple test for LRG that could be used in emergency rooms, Bachur said. "We could take urine and, in minutes, have an answer," he added.
He cautioned that the team has not yet studied potential markers in adults and they don’t know whether the same test would work. "Adult diseases are a little different," Bachur said.
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