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Diagnosis: Appendicitis

Published: July 25, 2009

Appendicitis, the most common cause of emergency surgery in youngsters, is notoriously difficult to diagnose with conventional blood tests and imaging studies such as CT scans and x-rays.

That may soon change.

Results of a study reported in the Annals of Emergency Medicine suggest that a new urine test detects a specific indicator of the disease. The discovery may reduce the risk of unneeded surgery as well the serious complications that sometimes occur when diagnosis takes too long.

“We found a biomarker in the urine of appendicitis patients (leucine-rich alpha 2 glycoprotein, or LRG), even in two patients whose imaging studies looked normal,” said lead study author Dr. Richard Bachur of Children’s Hospital in Boston, Massachusetts. “This could be a big step forward in the practice of pediatric emergency medicine, especially because urine is so easy to obtain. For a frightened and uncomfortable child, a simple test that either spares them surgery they don’t need or gets them into surgery before the appendix has ruptured could make a bad experience a little better.”

Experts say that 3 percent to 30 percent of appendectomies are found to be unnecessary, while delays in surgical treatment lead to rupture of the appendix in 30 percent to 45 percent of cases.

“Currently the [technology] needed to analyze urine for LRG is limited to large academic centers,” said Dr. Bachur. “However, clinical laboratory urine tests could be developed for rapid point of care testing. This could be a significant breakthrough in diagnosing and treating a common pediatric emergency.”

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