Letter to the Editor regarding Adams HL, Jaunoo SS. Hyperbilirubinaemia in appendicitis: the diagnostic value for prediction of appendicitis and appendiceal perforation. Eur J Trauma Emerg Surg. 2016; 42:249–52

Excerpt

With great interest, we read the paper “Hyperbilirubinaemia in appendicitis: the diagnostic value for prediction of appendicitis and appendiceal perforation” [ 1]. Appendicitis with subsequent indication for appendectomy is the daily business for every general surgeon and additive measures to secure the diagnosis, especially, in patients with ambiguous clinical presentation are greatly appreciated. However, we do not see the advantage of an additional parameter with a sensitivity/specificity profile, such as bilirubin levels (8 %/94 % and 9.4 %/93 % for acute and perforated appendicitis, respectively) measured in this paper. We wonder if those results changed the clinical decision and evaluation pathways in the authors’ hospital, especially in light of already published papers covering this topic [ 2]. Two prospective trials, carried out and published prior to their paper, resulted in an even more devastating verdict over this parameter, concluding it to be of limited value in clinical routine and not to be recommended to predict perforation in appendicitis [ 3, 4]. …