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White cell count and diagnosing appendicitis in adults
  1. Robert Williams, Clinical Fellow,
  2. Kevin Mackway-Jones, Professor
  1. Department of Emergency Medicine, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK; kevin.mackway-jones{at}man.ac.uk

    Abstract

    A short cut review was carried out to establish whether a single white cell count has clinical utility in the diagnosis of acute appendicitis in adults. Altogether 176 papers were found using the reported search, of which five presented the best evidence to answer the clinical question. The author, date, and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses of these best papers are tabulated. A clinical bottom line is stated.

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    Report by Robert Williams,Clinical FellowChecked by Kevin Mackway-Jones, Professor

    Clinical scenario

    A 24 year old man presents to the emergency department with a history and examination consistent with appendicitis. On referral, the duty surgeon requests a full blood count. You wonder whether it will aid the diagnosis.

    Three part question

    In [adults with suspected appendicitis] does [a single white cell count] aid [diagnosis]?

    Search strategy

    Medline 1966–06/02 using the OVID interface. [(exp Appendicitis OR acute appendicitis.mp) AND (exp Haematological tests OR exp Leukocyte count or leukocyte count$.mp OR neutrophil count$.mp OR white cell count$.mp OR inflammatory parameter$.mp or white blood count$)]. Limit to human and English.

    Search outcome

    Altogether 176 papers were found, of which 171 were irrelevant or of insufficient quality for inclusion. The remaining five papers are shown in table 3.

    Table 3

    Comment(s)

    All the reviewed studies have the weakness of no gold standard diagnostic test against which to compare the non-operative group. Only one study undertakes follow up of its non-operative group, with a single study formally recognising the fact that some abdominal pain, not requiring laparotomy, may have originated from the appendix. While all the studies seem to produce broad agreement as to the sensitivity and specificity of an isolated white cell count, they are not truly comparable because of the differing selection criteria of patients, age ranges, and clinical management. In addition there is a wide prevalence of disease between the groups.

    CLINICAL BOTTOM LINE

    A single white cell count is neither sensitive nor specific in the diagnosis of appendicitis.

    Report by Robert Williams,Clinical FellowChecked by Kevin Mackway-Jones, Professor

    References

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