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Plasma sodium as a predictor of perforation in acute appendicitis : A prospective multi-centre study

Lindestam, Ulf ; Norberg, Åke ; Svensson, Jan F ; Almström, Markus ; Andersson, Andreas ; Lönnqvist, Per-Arne ; Ellebæk, Mark Bremholm ; Bjørn, Niels ; Rajabaleyan, Pooya LU orcid and Drage, Inger Marie , et al. (2026) In Journal of Pediatric Surgery 61(7).
Abstract

BACKGROUND: Non-operative treatment for acute appendicitis (AA) in children has gained acceptance as an alternative to surgery in selected cases. Accurate preoperative differentiation between perforated and non-perforated AA is increasingly important, as the former requires emergency surgery while the latter may be managed conservatively. Previous research has suggested that low plasma sodium concentration (P-Na) may serve as a reliable predictor of perforation. This study aimed to evaluate the association between P-Na and appendiceal perforation in a prospective, multicentre paediatric cohort.

METHODS: Previously healthy children, aged 1-15 years, presenting with suspected AA who subsequently underwent appendectomy were enrolled... (More)

BACKGROUND: Non-operative treatment for acute appendicitis (AA) in children has gained acceptance as an alternative to surgery in selected cases. Accurate preoperative differentiation between perforated and non-perforated AA is increasingly important, as the former requires emergency surgery while the latter may be managed conservatively. Previous research has suggested that low plasma sodium concentration (P-Na) may serve as a reliable predictor of perforation. This study aimed to evaluate the association between P-Na and appendiceal perforation in a prospective, multicentre paediatric cohort.

METHODS: Previously healthy children, aged 1-15 years, presenting with suspected AA who subsequently underwent appendectomy were enrolled at five paediatric surgical centres (Stockholm, Oslo, Berlin, Odense and Cape Town). Blood sampling on admission included concentration of C-reactive protein, plasma sodium concentration, white blood cell count and neutrophil count.

RESULTS: 451 children met the inclusion criteria. Mean plasma sodium concentration on admission was lower in children with perforated AA as compared to non-perforated AA, mean 133.6 (standard deviation (SD) 4.0) mmol/l and 138.2 (SD 2.7) mmol/l respectively. A cut-off value of P-Na > 136 mmol/l resulted in an odds ratio of 0.11 (95% CI 0.07-0.17) for perforation. In a multivariate logistic regression analysis CRP and P-Na, respectively, were the strongest predictors of perforation. Combining the two resulted in an area under the curve of (AUC) of 0.86 in discriminating perforated AA from non-perforated AA.

CONCLUSIONS: In this large, prospective, multicentre study, low P-Na was independently associated with an increased risk of perforated AA in children. The predictive value improved when combined with CRP.

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publishing date
type
Contribution to journal
publication status
epub
subject
in
Journal of Pediatric Surgery
volume
61
issue
7
article number
163141
publisher
Elsevier
external identifiers
  • pmid:41985623
  • scopus:105036551052
ISSN
1531-5037
DOI
10.1016/j.jpedsurg.2026.163141
language
English
LU publication?
no
additional info
Copyright © 2026 The Author(s). Published by Elsevier Inc. All rights reserved.
id
9661a307-344e-45e1-88d7-7dffc99c6282
date added to LUP
2026-06-10 08:45:33
date last changed
2026-06-11 04:00:57
@article{9661a307-344e-45e1-88d7-7dffc99c6282,
  abstract     = {{<p>BACKGROUND: Non-operative treatment for acute appendicitis (AA) in children has gained acceptance as an alternative to surgery in selected cases. Accurate preoperative differentiation between perforated and non-perforated AA is increasingly important, as the former requires emergency surgery while the latter may be managed conservatively. Previous research has suggested that low plasma sodium concentration (P-Na) may serve as a reliable predictor of perforation. This study aimed to evaluate the association between P-Na and appendiceal perforation in a prospective, multicentre paediatric cohort.</p><p>METHODS: Previously healthy children, aged 1-15 years, presenting with suspected AA who subsequently underwent appendectomy were enrolled at five paediatric surgical centres (Stockholm, Oslo, Berlin, Odense and Cape Town). Blood sampling on admission included concentration of C-reactive protein, plasma sodium concentration, white blood cell count and neutrophil count.</p><p>RESULTS: 451 children met the inclusion criteria. Mean plasma sodium concentration on admission was lower in children with perforated AA as compared to non-perforated AA, mean 133.6 (standard deviation (SD) 4.0) mmol/l and 138.2 (SD 2.7) mmol/l respectively. A cut-off value of P-Na &gt; 136 mmol/l resulted in an odds ratio of 0.11 (95% CI 0.07-0.17) for perforation. In a multivariate logistic regression analysis CRP and P-Na, respectively, were the strongest predictors of perforation. Combining the two resulted in an area under the curve of (AUC) of 0.86 in discriminating perforated AA from non-perforated AA.</p><p>CONCLUSIONS: In this large, prospective, multicentre study, low P-Na was independently associated with an increased risk of perforated AA in children. The predictive value improved when combined with CRP.</p>}},
  author       = {{Lindestam, Ulf and Norberg, Åke and Svensson, Jan F and Almström, Markus and Andersson, Andreas and Lönnqvist, Per-Arne and Ellebæk, Mark Bremholm and Bjørn, Niels and Rajabaleyan, Pooya and Drage, Inger Marie and Stensrud, Kjetil Juul and Reismann, Marc and Donà, Annadiletta and Middleton, Pamela J and Meyer, Heidi M and Fläring, Urban}},
  issn         = {{1531-5037}},
  language     = {{eng}},
  month        = {{04}},
  number       = {{7}},
  publisher    = {{Elsevier}},
  series       = {{Journal of Pediatric Surgery}},
  title        = {{Plasma sodium as a predictor of perforation in acute appendicitis : A prospective multi-centre study}},
  url          = {{http://dx.doi.org/10.1016/j.jpedsurg.2026.163141}},
  doi          = {{10.1016/j.jpedsurg.2026.163141}},
  volume       = {{61}},
  year         = {{2026}},
}