White cell count and appendicitis in pregnancy
Date First Published:
March 1, 2000
Last Updated:
May 10, 2001
Report by:
Rob Williams, Clinical Fellow (Manchester Royal Infirmary)
Search checked by:
Kevin Mackway-Jones, Manchester Royal Infirmary
Three-Part Question:
In [pregnant women with a clinical diagnosis of appendicitis] is [a raised white cell count] useful in [diagnosis]?
Clinical Scenario:
A 27 year old woman who is 14 weeks pregnant, presents to the emergency department with the symptoms and signs of appendicitis. You refer the case to the acute surgical team who ask you to obtain a white cell count. You wonder whether this test has any value in this situation.
Search Strategy:
Medline 1966-05/00 using the OVID interface.
Search Details:
({exp appendicitis OR acute appendicitis.mp} AND {exp hematological tests OR exp leucocyte count OR leucocyte count$.mp OR neutrophil count$.mp OR white cell count$.mp OR inflammatory parameter$.mp OR white blood count$.mp} AND exp pregnancy OR exp pregnancy abdominal OR exp pregnancy complications OR pregnancy.mp) LIMIT to human AND english.
Outcome:
9 papers found of which 5 were irrelevant and 2 of insufficient quality for inclusion. The remaining 2 papers are shown in the table.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Appendectomy during pregnancy Doberneck RC. 1985, USA | 29 pregnant women undergoing appendectomy. | Retrospective survey | WCC > 10,000 | Sensitivity 85%; Specificity 33%; Positive likelihood ratio 1.28; Negative likelihood ratio 0.45 | Retrospective selection bias. Women undergoing appendectomy only. Small numbers. Incomplete data. |
| WCC > 15,000 | Sensitivity 50%; Specificity 89%; Positive likelihood ratio 4.5; Negative likelihood ratio 0.56 | ||||
| Appendicitis during pregnancy: Diagnosis, management and complications Andersen B and Nielsen TF 1999, Sweden | 56 pregnant women undergoing appendectomy. | Retrospective survey | WCC > 16,000 | Sensitivity 60%; Specificity 5%; Positive likelihood ratio 0.63; Negative likelihood ratio 8.4 | Retrospective selection bias. Women undergoing appendectomy only. Small numbers. Incomplete data. |
Author Commentary:
The only available studies deal with the wrong spectrum of patients. The women included all underwent appendicectomy; this is a selected sample of pregnant women presenting to emergency departments with the clinical signs and symptoms of appendicitis.
Bottom Line:
There is no evidence to support the use of isolated white cell counts in the diagnosis of acute appendicitis in pregnant women.
References:
- Doberneck RC.. Appendectomy during pregnancy
- Andersen B and Nielsen TF. Appendicitis during pregnancy: Diagnosis, management and complications