Key result
Preoperative white blood cell and neutrophil counts demonstrated limited diagnostic accuracy for acute appendicitis, with areas under the ROC curve of 0.701 and 0.680, respectively.
Why the study?
Do preoperative white blood cell and neutrophil counts accurately predict the presence and severity of acute appendicitis in patients undergoing appendectomy?
Observational (n=456)
No
Do preoperative white blood cell and neutrophil counts accurately predict the presence and severity of acute appendicitis in patients undergoing appendectomy?
Preoperative white blood cell and neutrophil counts have insufficient sensitivity and specificity to be relied upon as sole indicators for diagnosing acute appendicitis or determining its severity.
Answers are grounded in this paper and cite their sources.
Preoperative WBC and neutrophil counts should not guide appendicitis diagnosis alone; leaves open the need for superior biomarkers in prospective studies.
INTRODUCTION: Acute 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. METHODS: Medical 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. RESULTS: WBCs 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 × 103/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 × 103/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. CONCLUSIONS: Clinicians should not rely on either elevated WBCs or neutrophils count as appendicitis indicator as clinical data are superior in decision-making appendectomy.
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Zuhoor AlGaithy (2012) conducted an observational in Suspected acute appendicitis (n=456). White blood cell (WBC) and neutrophil counts vs. Histopathological diagnosis (normal appendix) was evaluated on Diagnostic accuracy (Area Under the ROC Curve) of WBC count for acute appendicitis (AUC 0.701, 95% CI 0.671-0.755). Preoperative white blood cell and neutrophil counts demonstrated limited diagnostic accuracy for acute appendicitis, with areas under the ROC curve of 0.701 and 0.680, respectively.
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