The Value of Laboratory Tests in Patients Suspected of Acute Appendicitis

Abstract

The clinical usefulness of laboratory tests was examined in 258 patients admitted to the emergency room with the general practitioner's tentative diagnosis, acute appendicitis. Acute appendectomy was perfonned on 91 patients. Histological examination of the appendix confirmed the diagnosis in 69 cases (acute appendicitis 20, phlegmonous appendicitis 36, Perforation 13). Seven patients with appendicular infiltrate were not subjected to Operation but the diagnosis was clear from clinical examination. On close examination/ Operation by the surgical team, 96 admitted patients were excluded from the primary diagnosis, acute appendicitis, and served äs a cpntrol group.Receiver Operating Characteristic curves (ROC-curves) showed that the sensitivity and specificity and hence diagnostic efficiency for total white blood cell count, number of segmented leukocytes and C-reactive protein concentration for the detection of acute appendicitis were higher than for erythrocyte Sedimentation rate, oc r antiproteinase concentration and body temperature. We observed that when all three parameters, C-reactive protein, white blood cell count and segmented leukocytes, are within the normal ränge the diagnosis, acute appendicitis is highly unlikely.The diagnostic value of the different laboratory parameters appears, moreover, to be highly dependent on the degree of inflammation/pefforation and the development of appendicular Infiltration. However, diagnostic efficiency can be irnproved, and unnecessary surgery prevented, by perfofmance of an appropriately selected combination of laböfatory tests combined with evalUation of clinical Symptoms.

Is magnetic resonance imaging a viable alternative to ultrasound as the primary imaging modality in the diagnosis of paediatric appendicitis? A systematic review

“…Total Leukocyte Count (TLC), C-reactive protein; neutrophil count). 11,[13][14][15] In children, appendicitis may not present with such typical symptoms. 11,12 Instead, while childhood appendicitis may present initially with periumbilical pain, symptom progression may lead to flatulence, bowel irregularity/diarrhoea, indigestion, and general malaise.…”

Clinical value of Leukocyte counts in evaluation of patients with suspected appendicitis in emergency department

“…[6,12] However, in some, only the appearance of the ROC curve was used or the AUC was calculated without reporting the cut-off value with the highest sensitivity and specificity.…”

“…Only a few have used receiver operating characteristic (ROC) curve analysis in patients with suspected acute appendicitis, but either without calculating the area under the ROC curve (AUC) or without defining the cut-off values with highest sensitivity and specificity. [5,6] However, in this continuous variable, ROC curve analysis is a statistically more appropriate approach.…”

Role of Serum C-Reactive Protein Levels in Diagnosis of Acute Appendicitis

“…(1,2,3,4) The classic triad of history compatible with acute appendicitis, pain at Mc Burney's point and leukocytosis has a diagnostic accuracy rate of less than 80 percent, and even when radiological technique such as ultrasonography, computed tomography are included, the accuracy does not reach 90 percent. (5,6,7,8,9,10) This is especially true in females and in the extremes of age. (1,2,3,4) The accurate diagnosis is very important as a diagnosis of acute appendicitis needs immediate surgery while other diagnosis may not require surgery (11) .…”