Evaluation of Serial C-Reactive Protein as a Predictor of Surgical Site Infection Following Emergency Laparotomy in Children in Ile-Ife, Nigeria

Adumah Collins Chijioke

Department of Surgery, Babcock University Teaching Hospital, Nigeria

^*Correspondance to: Adumah Collins Chijioke 

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Abstract:

Background: Effective monitoring of patients post operatively may reduce morbidity and mortality in children undergoing emergency laparotomy and thus improve outcome. Early detection of complications post operatively is a very challenging task due to inadequate facilities for monitoring in our environment. C-Reactive Protein (CRP) may be used as an adjunct to clinical parameters for early detection of complications and prompt institution of treatment C-reactive protein is an effective, reliable, easy, fast and minimally invasive diagnostic modality for monitoring pediatric patients post operatively.
Objective: The aim of this study was to determine if serum CRP could predict surgical site infection in children who had emergency laparotomy.
Methodology: This was a prospective study carried out in the pediatric surgery Unit of the Obafemi Awolowo Teaching Hospitals Complex, Ile Ife, over a period of one year. All patients presenting with acute abdominal condition requiring surgery at the children emergency room were recruited into the study after informed consent had been obtained from their parents or guardians. Following adequate resuscitation, blood sample was collected to measure the preoperative CRP level. Post operatively, serial blood samples were collected at 24 h interval over a six day period for CRP estimation using ELISA method. Six hourly vital signs (Blood pressure, pulse rate, temperature, and respiratory rate) together with daily abdominal examination were done for 6 days post operatively to detect surgical site infection. Abdominopelvic ultrasound was done on days 4 and 6 to rule out intra-abdominal collection. Demographic, clinical and measured CRP levels were entered into a proforma and analyzed using SPSS software version 22 (SPSS Inc, Chicago, Illinois). A criterion of P<0.05 was used to determine statistical significance.
Results: Thirty seven patients were recruited for the study with a mean age of 9.06 ± years and age range of 6 months to 15 years. There were 24 males (64.8%) and 13 females (35.2%). The mean preoperative level of serum CRP was 122.65 ± 88.1 mg/L (normal value: <3 mg/L) Thirteen (35.1%) patients had surgical site infection. The mean serum CRP of the patients with normal postoperative course peaked at 48 h post-surgery and then steadily declined. The patients who developed surgical site infection had an accelerated rise in mean serum CRP post operatively compared to the patients without surgical site infection. Their serum CRP continued to rise up to 144 hours post-surgery. The result also showed that elevation of mean serum CRP in those who developed surgical site infection predated the earliest change in their clinical signs by 12 h.
Conclusion: The study showed that the mean preoperative CRP level is elevated above the normal range in children undergoing emergency laparotomy in OAUTHC Ile Ife. The mean serum CRP continues to rise and peaks at 48 h after surgery and then maintains a downward trend in patients with normal post-operative course while for patients with surgical site infection, it still maintains an upward trend 48 h after surgery. Serum CRP identified those who develop surgical site infections by 3rd post-operative day.

Keywords:

C-reactive protein; Postoperative monitoring; Surgical site infection

Cite the Article:

Chijioke AC. Evaluation of Serial C-Reactive Protein as a Predictor of Surgical Site Infection Following Emergency Laparotomy in Children in Ile-Ife, Nigeria. World J Surg Surgical Res. 2019; 2: 1138.