White cell count and diagnosing appendicitis in children
Date First Published:
March 1, 2000
Last Updated:
September 16, 2002
Report by:
Robert Williams, Clinical Fellow (Manchester Royal Infirmary)
Search checked by:
Kevin Mackway-Jones, Manchester Royal Infirmary
Three-Part Question:
In [children with suspected appendicitis] does [a single white cell count] aid [diagnosis]?
Clinical Scenario:
A 6 year old individual presents to the Emergency Department with a history and examination consistent of appendicitis. On referral, the duty surgeon requests a full blood count. You wonder whether it will aid the diagnosis.
Search Strategy:
Medline 1966-06/02 using the OVID interface.
Search Details:
[{exp Appendicitis OR acute appendicitis.mp} AND {exp Haematological tests OR exp Leukocyte count OR leukocyte count$.mp OR neutrophil count$.mp OR white cell count$.mp OR inflammatory parameter$.mp} AND exp Diagnosis AND {exp adolescence OR exp child OR exp child of impaired parents OR exp child, abandoned OR exp child, exceptional OR exp child, hospitalised OR exp child, institutionalised OR exp child, preschool OR exp child, unwanted OR exp disabled children OR exp homeless youth OR exp infant OR exp only child OR child$.mp Or exp Pediatrics OR pediatric$.mp OR paediatric$.mp}]. LIMIT to human AND English
Outcome:
100 papers were found of which 96 were irrelevant or of insufficient quality. The remaining 4 papers are shown in the table.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Leucocyte counts in the diagnosis and prognosis of acute appendicitis in children. Doraiswamy NV. 1979, UK | 375 children admitted with clinical diagnosis of acute appendicitis 225 found to have acute appendicitis, 50 with a normal appendix, and 100 in whom symptoms resolved spontaneously |
Diagnostic test study | WCC>15 000 (0-10) or WCC>10 000 (10-15) | Sens 42%; Spec 97%; LR+ 12.5; LR- 0.60 | Unclear if blinded No gold standard No follow up of non-operative cases |
| The white cell count in acute appendicitis. A prospective blind study. Miskowiak J, Burcharth F. 1982, Denmark | 238 patients admitted with suspected acute appendicitis 74 were below 15 years |
Diagnostic test study, blinded | WCC>15 000 | Sens 19%; Spec 85%; LR+ 1.26; LR- 0.95 | No gold standard |
| C-reactive protein compared with white blood rate and erythrocyte sedimentation count in the diagnosis of acute appendicitis in children. Peltola H, Ahlqvist J, Rapola J, et al. 1986, Sweden | 162 children (1.9-15.6) admitted with suspected acute appendicitis | Diagnostic test study | WCC>15 000. Histology | Sens 60 %; Spec 84%; LR+ 3.75; LR- 0.48 | Unclear if blinded No gold standard No follow up of non-operative cases |
| Leucocyte count and neutrophil percentage in appendicectomy for suspected appendicitis. Lau WY, Ho YC, Chu KW, et al. 1989, Australia | 1389 patients (1-87), with right lower abdominal pain, consistent with appendicitis 177 children (1-15) Non-operative group followed up at 2 and 6 weeks |
Diagnostic test study, blinded | WCC>15 000 (group 1-10). WCC>13 000 (group 10-15). Histology | Sens 60.5%; Spec 100%; LR+ INF; LR- 0.35 | No gold standard Not analysed by age specific WCC Raw data not available for analysis by age group |
Author Commentary:
The majority of studies looked at absolute values of white cell counts in appendicitis and were of little use in evaluating its use as a diagnostic test. Although the paper by Lau et al is well constructed, it assesses two different ranges for the analysis, which may affect the results. Without data on the numbers within each group, their claim for 100% specificity, and infinite positive likelihood ratio must be interpreted with care.
Bottom Line:
A single white cell count is neither sensitive nor specific in the diagnosis of appendicitis in children.
References:
- Doraiswamy NV.. Leucocyte counts in the diagnosis and prognosis of acute appendicitis in children.
- Miskowiak J, Burcharth F.. The white cell count in acute appendicitis. A prospective blind study.
- Peltola H, Ahlqvist J, Rapola J, et al.. C-reactive protein compared with white blood rate and erythrocyte sedimentation count in the diagnosis of acute appendicitis in children.
- Lau WY, Ho YC, Chu KW, et al.. Leucocyte count and neutrophil percentage in appendicectomy for suspected appendicitis.