title: Serial white blood cell counts in trauma: do they predict a hollow viscus injury?
abstract: BACKGROUND
  The significance of serial white blood cell (WBC) counts in trauma patients with a suspected hollow viscus injury (HVI) is unknown. The purpose of this study was to examine the role of serial WBC counts in the diagnosis of a HVI.
  
  
  METHODS
  After institutional review board approval, all injured patients admitted to a Level I trauma center from January 2003 to December 2007 with at least one WBC measurement were included in a retrospective analysis. The WBC profiles for patients with a HVI were compared against those without HVI. All WBC counts are reported as [x10(3)/microL].
  
  
  RESULTS
  The mean WBC count of the overall study population (n = 5,950) on admission was 11.6 +/- 5.3. Overall, 59.2% had an elevated WBC count on admission. A significant relationship between increasing Injury Severity Score and increasing WBC count on admission was found by linear regression. When comparing patients with HVI (n = 267) with patients without HVI (n = 5,683), no significant difference was found for admission WBC count. The highest WBC count within the first 24 hours for patients with HVI was 16.7 +/- 4.7. This was significantly higher than that for the 4,520 patients without any intraabdominal injury (13.0 +/- 5.2, adjusted p < 0.001). Penetrating injury, a concomitant severe thoracic trauma (chest Abbreviated Injury Scale value >or=3), and highest WBC count >or=20.0 in the first 24 hours were independent risk factors for HVI. A maximal WBC count <or=12.5 in the first 24 hours was independently associated with a lower incidence of HVI. The area under the receiver operating characteristic curve for the highest WBC count in the first 24 hours for predicting HVI was 0.723 (95% CI: 0.656-0.790).
  
  
  CONCLUSIONS
  Multiple variables likely impact the WBC count in trauma patients. WBC count elevation on admission is nonspecific and does not predict the presence of a HVI. With serial measurements, WBC counts >or=20.0 are independently associated with a HVI, whereas counts <or=12.5 rule against the presence of HVI. However, the sensitivity of these cutoff values to predict a HVI is poor. The diagnostic value of serial WBC counts for predicting a HVI within the first 24 hours after trauma is very limited.
authors.affiliation: Division of Trauma and Surgical Critical Care, Los Angeles County Medical Center, University of Southern California, Los Angeles, California, USA.
authors.forename: Beat
authors.initials: B
authors.lastname: Schnüriger
authors.forename: Kenji
authors.initials: K
authors.lastname: Inaba
authors.forename: Galinos
authors.initials: G
authors.lastname: Barmparas
authors.forename: Barbara M
authors.initials: BM
authors.lastname: Eberle
authors.forename: Thomas
authors.initials: T
authors.lastname: Lustenberger
authors.forename: Lydia
authors.initials: L
authors.lastname: Lam
authors.forename: Peep
authors.initials: P
authors.lastname: Talving
authors.forename: Demetrios
authors.initials: D
authors.lastname: Demetriades
mesh_terms: D000007:Abdominal Injuries / Q000097:blood* / Q000145:classification / Q000175:diagnosis / Q000401:mortality; D000328:Adult; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D007958:Leukocyte Count / Q000379:methods*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D013898:Thoracic Injuries / Q000097:blood* / Q000145:classification / Q000175:diagnosis / Q000401:mortality; D014949:Wounds, Nonpenetrating / Q000097:blood* / Q000145:classification / Q000175:diagnosis / Q000401:mortality; D014950:Wounds, Penetrating / Q000097:blood* / Q000145:classification / Q000175:diagnosis / Q000401:mortality; D055815:Young Adult