Article Text

Download PDFPDF

White cell count and diagnosing appendicitis in children
  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}


    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 children. Altogether 100 papers were found using the reported search, of which four 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.

    Statistics from

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

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

    Clinical scenario

    A 6 year old child presents to the emergency department with a history and examination consistent of appendicitis. On referral, the duty surgeon requests a full blood count. You wonder whether it will aid the diagnosis.

    Three part question

    In [children 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} 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} AND exp Diagnosis AND {exp adolescence OR exp child OR exp child of impaired parents OR exp child, abandoned OR exp child, exceptional OR exp child, hospitalised OR exp child, institutionalised OR exp child, preschool OR exp child, unwanted OR exp disabled children OR exp homeless youth/ OR exp infant OR exp only child OR child$.mp Or exp Pediatrics OR pediatric$.mp OR paediatric$.mp}]. Limit to human AND English.

    Search outcome

    Altogether 100 papers were found of which 96 were irrelevant or of insufficient quality. The remaining four papers are shown in table 2.


    The majority of studies looked at absolute values of white cell counts in appendicitis and were of little use in evaluating its use as a diagnostic test. Although the paper by Lau et al is well constructed, it assesses two different ranges for the analysis, which may affect the results. Without data on the numbers within each group, their claim for 100% specificity, and infinite positive likelihood ratio must be interpreted with care.


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

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