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World Journal of Emergency Surgery

, 7:32

First Online: 02 October 2012Received: 20 July 2012Accepted: 03 September 2012


IntroductionAcute appendicitis AA is common surgical problem associated with acute-phase reaction. Blood tests role in decision-making process is unclear. This retrospective study aimed to determine diagnostic value of preoperative evaluation of white blood cells WBCs and neutrophils and its value in predicting AA severity.

MethodsMedical records of 456 patients who underwent appendectomy during 4-years period were retrospectively reviewed. Patients were subdivided according to histological finding into: normal appendix n = 29, uncomplicated inflamed appendix n = 350, complicated appendicitis n = 77. Diagnostic performances of WBCs and neutrophils were analyzed using receiver operating characteristic ROC curves.

ResultsWBCs and neutrophils counts were higher in patients with inflamed and complicated appendix than normal appendix and in complicated than inflamed appendix. In patients, WBCs count 9.400 × 10-mL had sensitivity of 76.81%, specificity of 65.52%, positive predictive value PPV of 97.0%, negative predictive value NPV of 16.1%, positive likelihood ratio LR+ of 2.23, negative LR− of 0.35. Neutrophil count 7.540 × 10-mL had sensitivity of 70.96%, specificity of 65.52%, PPV of 96.8%, NPV of 13.3%, LR+ of 2.06, LR− of 0.44. Areas under ROC curve were 0.701, 0.680 for elevated WBCs and neutrophils count.

ConclusionsClinicians should not rely on either elevated WBCs or neutrophils count as appendicitis indicator as clinical data are superior in decision-making appendectomy.

KeywordsAcute appendicitis Diagnosis White blood cells Histological diagnosis Neutrophil count Receiver operating characteristic curves AbbreviationsAAAcute appendicitis

AUCArea under curve

LRLikelihood ratios

NPVNegative predictive value

PPVPositive predictive value

ROCReceiver operating characteristic curves

WBCsWhite blood cells.

Electronic supplementary materialThe online version of this article doi:10.1186-1749-7922-7-32 contains supplementary material, which is available to authorized users.

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Author: Zuhoor K Al-gaithy


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