Experimental Urine Test Spots Appendicitis

Holds promise for faster, more accurate diagnoses, researchers say

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HealthDay Reporter

TUESDAY, June 23, 2009 (HealthDay News) -- A new urine test may one day spot appendicitis faster and more accurately than current tests do, researchers report.

Appendicitis is the most common surgical emergency in children, but the diagnosis can be challenging. An incorrect diagnosis can either lead to unnecessary surgery or a ruptured appendix with serious complications.

"We have found a protein in the urine that is diagnostic for appendicitis," said study co-author Hanno Steen, director of the Proteomics Center at Children's Hospital Boston. "This would mean that diagnosis of appendicitis is faster, more reliable and much more cost-efficient."

Ultrasound and computed tomography scans are used to diagnose appendicitis, yet 3 percent to 30 percent of children have unnecessary appendectomies, while 30 percent to 45 percent of those diagnosed with appendicitis already have a ruptured appendix, Steen noted.

In addition, patients can wait hours in the emergency room before they are able to have these tests, Steen said.

The report is published in the June 23 online edition of the Annals of Emergency Medicine.

For the study, Steen's team looked at urine samples from six patients with appendicitis and six without appendicitis. The researchers identified 32 possible biomarkers associated with the condition. To these, they added other markers found in gene studies.

Steen's group then looked for these 57 potential markers in 67 children with possible appendicitis. Among these children, 25 actually did have appendicitis, the researchers noted.

From this study, the researchers identified seven biomarkers linked with appendicitis. Of these, leucine-rich alpha-2-glycoprotein appeared to be the best -- with few false-positive or false-negative results.

Based on these results, Steen's group hopes to develop a rapid clinical test, such as a urine dipstick, that could be widely used to identify children and adults with appendicitis.

This test could diagnose appendicitis in 30 minutes and result in fewer unnecessary surgeries, Steen said.

But first, the test has to be tried in a larger group of patients, Steen said. In addition, they want to test the findings in adults.

"We have to show the test works in adults," Steen said. "We also have to do a much larger study so we can do proper statistics."

Dr. Marshall Morgan, chief of emergency medicine at UCLA Medical Center in Los Angeles, said he thinks this preliminary study could result in a better way to diagnose appendicitis in the future.

"This is interesting, even exciting, in that it describes a new approach to a difficult and common diagnostic problem," Morgan said. "On the other hand, this is early work which is not nearly ready for clinical application at this point."

More information

For more information on appendicitis, visit the U.S. National Institute of Diabetes and Digestive and Kidney Diseases.

SOURCES: Hanno Steen, Ph.D., director, Proteomics Center, Children's Hospital Boston; Marshall Morgan, M.D., director, emergency medicine, UCLA Medical Center, Los Angeles; June 23, 2009, Annals of Emergency Medicine, online

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