Appendicitis

Appendicitis can be tricky to diagnose in children. Even with improved radiologic imaging, many children undergo unnecessary surgery, while others are only diagnosed after their appendix has already burst. Now, teaming up with Hanno Steen, PhD, director of Boston Children's Hospital's Proteomics Center, emergency physicians Richard Bachur, MD, and Alex Kentsis, MD, PhD, have identified a "biomarker" for appendicitis that can be picked up with a urine test, potentially allowing diagnosis in a matter of minutes.

Laboratory biomarkers for appendicitis have been found in the past, but none have proved reliable enough to be clinically useful. "Recent diagnostic advances have focused on advanced radiologic procedures, such as computed tomography and ultrasound, but these can delay diagnosis and aren't universally available," says Bachur, acting chief of Emergency Medicine. "CT scans also expose children to radiation that may increase their risk of cancer."

The team took urine samples from 67 children with possible appendicitis, 25 of whom had proven cases. They then used mass spectrometry, a technique that detects and quantifies proteins in a sample, to test for 57 potential markers. One, leucine-rich alpha-2-glycoprotein (LRG), emerged as the best of the group, detecting or ruling out appendicitis with few false positives or negatives.

Bachur and Kentsis now plan to validate their findings using clinically available tests. Steen predicts that proteomics will provide diagnostic markers for many more pediatric diseases in the future. The report was published online June 23 by the Annals of Emergency Medicine.