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Report by Rob Williams, Clinical Fellow Search checked by Kevin Mackway-Jones, Consultant
Clinical scenario
A 27 year old woman who is 14 weeks pregnant, presents to the emergency department with the symptoms and signs of appendicitis. You refer the case to the acute surgical team who ask you to obtain a white cell count. You wonder whether this test has any value in this situation.
Three part question
In [pregnant women with a clinical diagnosis of appendicitis] is [a raised white cell count] useful in [diagnosis]?
Search strategy
Medline 1966–06/00 using the OVID interface. ({exp appendicitis OR appendicitis.mp} AND {exp leukocyte count OR leukocyte count$.mp OR neutrophil count$.mp OR white cell count$.mp} AND {exp pregnancy OR pregnancy.mp}) LIMIT to human AND english.
Search outcome
Altogether seven papers found of which five were irrelevant or of insufficient quality for inclusion. The remaining two papers are shown in table 2.
Comments
The only available studies deal with the wrong spectrum of patients. The women included all underwent appendicectomy; this is a selected sample of pregnant women presenting to emergency departments with the clinical signs and symptoms of appendicitis.
Clinical bottom line
There is no evidence to support the use of isolated white cell counts in the diagnosis of acute appendicitis in pregnant women.
Report by Rob Williams, Clinical Fellow Search checked by Kevin Mackway-Jones, Consultant