Lack of utility of measuring serum bilirubin concentration in distinguishing perforation status of pediatric appendicitis

Am J Emerg Med. 2017 Jun;35(6):885-888. doi: 10.1016/j.ajem.2017.01.056. Epub 2017 Jan 27.


Background: Pediatric appendicitis is a common, potentially serious condition. Determining perforation status is crucial to planning effective management.

Purpose: Determine the efficacy of serum total bilirubin concentration [STBC] in distinguishing perforation status in children with appendicitis.

Methods: Retrospective review of 257 cases of appendicitis who received abdominal CT scan and measurement of STBC.

Results: There were 109 with perforation vs 148 without perforation. Although elevated STBC was significantly more common in those with [36%] vs without perforation [22%], the mean difference in elevated values between groups [0.1mg/dL] was clinically insignificant. Higher degrees of hyperbilirubinemia [>2mg/dL] were rarely encountered [5%]. Predictive values for elevated STBC in distinguishing perforation outcome were imprecise [sensitivity 38.5%, specificity 78.4%, PPV 56.8%, NPV 63.4%]. ROC curve analysis of multiple clinical and other laboratory factors for predicting perforation status was unenhanced by adding the STBC variable. Specific analysis of those with perforated appendicitis and percutaneously-drained intra-abdominal abscess which was culture-positive for Escherichia coli showed an identical rate of STBC elevation compared to all with perforation.

Conclusions: The routine measurement of STBC does not accurately distinguish perforation status in children with appendicitis, nor discern infecting organism in those with perforation and intra-abdominal abscess.

Keywords: Appendicitis; Perforation; Serum bilirubin concentration.

MeSH terms

  • Abdominal Abscess / blood*
  • Abdominal Abscess / diagnosis*
  • Adolescent
  • Appendicitis / blood*
  • Appendicitis / diagnosis*
  • Bilirubin / blood*
  • Child
  • Child, Preschool
  • Diagnosis, Differential
  • Female
  • Humans
  • Hyperbilirubinemia / epidemiology
  • Male
  • Predictive Value of Tests
  • ROC Curve
  • Retrospective Studies
  • Tomography, X-Ray Computed
  • United States


  • Bilirubin