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 18 February 2018

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News

White Blood Cell count and temperature in evaluation of suspected appendicitis

October's issue of Academic Emergency Medicine publishes a report that finds no clinical utility for WBC count in cases of suspected appendicitis and minimal statistical association between temperature and presence of appendicitis.

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The total white blood cell (WBC) count and temperature are often expected to be elevated in patients with appendicitis.

Clinicians often use the results of these parameters in making a judgment about the presence or absence of disease.

Dr Cardall, Dr Glasser and Dr Guss from San Diego, California, assessed the discriminatory value of the total WBC count and presenting body temperature in patients presenting to the emergency department (ED) with signs and symptoms suggestive of appendicitis.

The researchers carried out this prospective consecutive case series in a university ED, with an annual census of 38,000.

The doctors enrolled all patients presenting to the department in whom the diagnosis of appendicitis was the attending physician's primary consideration.

Elevated total WBC count >10,000 cells/mm3 is statistically associated with the presence of appendicitis
Academic Emergency Medicine

The team recorded measures such as age, gender, symptoms, physical findings, patient temperature as taken in the ED, initial total WBC count, and discharge diagnosis.

The admitted patients were followed up by the research group until surgical or clinical outcomes, and discharged patients were followed up by telephone two weeks after the initial visit.

In total, the researchers enrolled 293 patients over a two-year study period.

The doctors measured total WBC count in 274 cases, and temperature in 293 cases.

Out of these participants, 130 were male and 163 were female.

The mean age of the patients was 30.8 years (range, 7–75 years).

The doctors confirmed appendicitis in 92 patients.

The researchers found that an elevated total WBC count >10,000 cells/mm3, while statistically associated with the presence of appendicitis, had very poor sensitivity and specificity and almost no clinical utility.

In addition, there was minimal statistical association between a temperature of >99°F and the presence of appendicitis.

On analysis, the group found that there is no value of total WBC count or temperature that has sufficient sensitivity and specificity to be of clinical value in the diagnosis of appendicitis.

Dr Guss concluded, "Clinicians should be wary of reliance on either elevated temperature or total WBC count as an indicator of the presence of appendicitis."

Academic Emergency Medicine; 2004: 11 (10): 1021-1027
11 October 2004

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