WHITE
BLOOD CELL COUNT IS A POOR PREDICTOR OF SEVERITY OF DISEASE IN THE DIAGNOSIS OF
APPENDICITIS.
Coleman
C, et al. Am Surg 1998 Oct;64(10):983-5
BACKGROUND:
The white blood cell (WBC) count is considered to be a useful test in the
diagnosis of appendicitis. The purpose of this study was to examine the
clinical features of patients with normal WBC appendicitis and also to
determine whether a higher WBC count correlates with a more advanced stage of
appendicitis.
METHODS:
Patients with pathologically confirmed appendicitis from January 1989 to
December 1994 were included in the study (n = 1919). The age, gender,
temperature, length of hospital stay, and severity of disease (1 = acute
appendicitis; 2 = gangrenous appendicitis; 3 = perforated appendicitis with
abscess formation; 4 = appendicitis with diffuse peritonitis) were compared for
patients with a normal WBC count (range, 3.8-10.9) versus those who had an
elevated WBC count.
RESULTS:
A normal WBC count was seen in 11 per cent of patients (n = 209). There was no
difference in age, temperature, gender, or severity of disease in the patients
with a normal WBC count compared with those with an elevated WBC count (P >
0.05). The severity of disease of patients with a normal WBC count were: 1 = 58
per cent; 2 = 13 per cent; 3 = 7 per cent; and 4 = 22 per cent. For patients
with an elevated WBC count the scores were: 1 = 57 per cent; 2 = 17 per cent; 3
= 13 per cent; and 4 = 14 per cent. The proportion of gangrenous and perforated
appendicitis in the patients with a normal WBC count is the same as in the
patients with an elevated WBC count.
CONCLUSION:
There was no difference in age, temperature, gender, or severity of disease in
the patients with a normal WBC count compared with those with an elevated WBC
count.
COMMENTS:
For a good review article, read Snyder BK & Hayden SR, Accuracy Of
Leukocyte Count In The Diagnosis Of Acute Appendicitis, Ann Emerg Med
33(5):565, May 1999.