hyperbilirubinemia as an indicator of complicated appendicitis

Introduction: Appendicitis is a common presentation in the surgical emergency. Of these 34.7% are perforated or gangrenous. Delay in diagnosis of complicated appendicitis can lead to increase in operative burden and ensuing morbidity. Hyperbilirubinemia is a non invasive and cost effective diagnostic tool for complicated appendicitis. Prioritization of patients on operating lists and reduction in unnecessary investigations may be possible with accurate and timely diagnosis of the disease. Objectives: To determine the diagnostic accuracy of Hyperbilirubinemia in diagnosing complicated appendicitis keeping histopathology as gold standard. Study design:Descriptive, cross-sectional. Study duration:21st November 2015 to 20th May 2016 Settings:Surgical Unit 1 Holy Family Hospital Rawalpindi Pakistan Materials & Methods: A total of 185 suspected cases of acute appendicitis undergoing appendectomy between ages of 12-60 years of either gender were recruited. Total bilirubin levels were sent preoperatively. Appendectomy was performed and specimen sent in formalin bottles, histopathological diagnosis was traced. Results: Mean age was 24.16 ± 11.69 years. Out of 185 patients, 100 (54.05%) were male and 85 (45.95%) were females.In Hyperbilirubinemia positive patients, 30 (True Positive) had complicated appendicitis and 06 (False Positive) had simple appendicitis on histopathology. Among 149 patients with normal total bilirubin, 23 (False Negative) had complicated appendicitis whereas 126 (True Negative) did not have complicated appendicitis on histopathology(p=0.0001).Overall sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of Hyperbilirubinemia in diagnosing complicated appendicitis was 56.60%, 95.45%, 83.33%, 84.56% and 84.32% respectively. Conclusion: Hyperbilirubinemia at presentation is an accurate and specific indicator of complicated appendicitis.