title: Clinical value of total white blood cells and neutrophil counts in patients with suspected appendicitis: retrospective study.
abstract: BACKGROUND
  Acute appendicitis (AA) is common surgical problem associated with acute-phase reaction. Blood tests role in decision-making process is unclear. This retrospective study aimed to determine diagnostic value of preoperative evaluation of white blood cells (WBCs) and neutrophils and its value in predicting AA severity.
  
  
  METHODS
  Medical records of 456 patients who underwent appendectomy during 4-years period were retrospectively reviewed. Patients were subdivided according to histological finding into: normal appendix (n = 29), uncomplicated inflamed appendix (n = 350), complicated appendicitis (n = 77). Diagnostic performances of WBCs and neutrophils were analyzed using receiver operating characteristic (ROC) curves.
  
  
  RESULTS
  WBCs and neutrophils counts were higher in patients with inflamed and complicated appendix than normal appendix and in complicated than inflamed appendix. In patients, WBCs count 9.400 × 103/mL had sensitivity of 76.81%, specificity of 65.52%, positive predictive value (PPV) of 97.0%, negative predictive value (NPV) of 16.1%, positive likelihood ratio [LR(+)] of 2.23, negative LR(-) of 0.35. Neutrophil count 7.540 × 103/mL had sensitivity of 70.96%, specificity of 65.52%, PPV of 96.8%, NPV of 13.3%, LR(+) of 2.06, LR(-) of 0.44. Areas under ROC curve were 0.701, 0.680 for elevated WBCs and neutrophils count.
  
  
  CONCLUSIONS
  Clinicians should not rely on either elevated WBCs or neutrophils count as appendicitis indicator as clinical data are superior in decision-making appendectomy.
authors.affiliation: Department of Surgery, King Abdulaziz University, P,O, Box 80215, Jeddah, 21589, Saudi Arabia. zkngaithy@hotmail.com.
authors.forename: Zuhoor K
authors.initials: ZK
authors.lastname: Al-Gaithy