Percentage of Neutrophils and Neutrophil-to-Lymphocyte Ratio in Distinguishing Late from Early Prehospital Presentation of Perforated Appendicitis in Children.

Introduction: White blood cell subtypes are commonly used to diagnose paediatric cases of perforated appendicitis (PA). In this study, an attempt was made to examine changes in white blood cell subtypes based on the duration of symptoms before hospitalization. Authors believe that findings will be able to describe cases of PA with delayed presentation, more accurately.

Materials and methods: A retrospective study was conducted on 139 children with diagnosis of PA admitted between 2020 and 2023. Children were divided into two groups: Group I (n = 95), with early prehospital presentation of PA (symptoms before hospitalization lasting less than 48 hours), and Group II (n = 44), with late prehospital presentation of PA (symptoms before hospitalization lasting more than 48 hours). Medical documentation and data referring to the clinical features and laboratory markers were gathered and compared between groups.

Results: Delayed prehospital presentation of PA had 31.65% of patients. White blood cell counts, neutrophil percentages and absolute counts, and the ratios of neutrophils to lymphocytes (ANC/ALC) and neutrophils to monocytes (ANC/AMC) were all lower in Group II. Furthermore, Group II had notably greater levels of C-reactive protein and higher percentages of lymphocytes and monocytes. The percentage of neutrophils and cutoff value was 78.95%, whereas the ANC/ALC ratio cutoff was 6.58. The percentage of neutrophils had a sensitivity and specificity of 75.0% and 62.8%, respectively, while ANC/ALC had a sensitivity and specificity of 81.3% and 51.2%, respectively.

Conclusions: The percentage of neutrophils and neutrophil-to-lymphocyte ratio can help distinguish between the late and early prehospital presentation of PA in children and may improve the accuracy of prehospital diagnosis. Less than 78.95% and 6.58, percentage of neutrophils and neutrophil-to-lymphocyte ratio, respectively, are indicative in late prehospital presentation of paediatric PA.