title: Total leukocyte and neutrophil count as preventive tools in reducing negative appendectomies.
abstract: BACKGROUND
  Negative appendectomies result in unnecessary admissions, health care burden, and cost. This study was conducted to assess total leukocyte and neutrophil counts as preventive tools in reducing negative appendectomies.
  
  
  METHODS
  Data of admitted patients who underwent appendectomies was analyzed. Receiver operator characteristic (ROC) curve analysis of total leukocyte and neutrophil counts was calculated for various cut-off points. Optimum sensitivity, specificity, overall accuracy, and area under the curve was determined.
  
  
  RESULTS
  Of the four hundred and eightpatients, true and negative appendicitis by operative assessment was 294 (72.1%) and 114 (27.9%) compared to 311 (76.2%) and 97 (23.8%) by histopathology, respectively. Optimal cut-off for total leukocyte count was >11.9x10(9)/Liter with 87.14% sensitivity and 91.75% specificity. Optimal cut-off point for neutrophil count was >7.735x10(9)/Liter with 98.71% sensitivity and 91.75% specificity. Area under the curve for total leukocyte and neutrophil counts was 0.9603 and 0.9872, respectively with overall accuracy of 91.2% and 97.1%, respectively.
  
  
  CONCLUSIONS
  Normal total leukocyte and neutrophil counts are strongly associated with negative appendectomies. Non-operative measures and careful observation of total leukocyte and neutrophil counts are of paramount importance.
authors.affiliation: Department of Surgical, Khyber Teaching Hospital, Peshawar, Pakistan. drsalmanrafiq@hotmail.com.
authors.forename: Muhammad Salman
authors.initials: MS
authors.lastname: Rafiq
authors.affiliation: Department of Surgical, Khyber Teaching Hospital, Peshawar, Pakistan.
authors.forename: Mah Muneer
authors.initials: MM
authors.lastname: Khan
authors.affiliation: Department of Surgical, Khyber Teaching Hospital, Peshawar, Pakistan.
authors.forename: Ataullah
authors.initials: A
authors.lastname: Khan
authors.affiliation: Department of Surgical, Khyber Teaching Hospital, Peshawar, Pakistan.
authors.forename: Bilal
authors.initials: B
authors.lastname: Ahmad
mesh_terms: D001064:Appendicitis / Q000097:blood / Q000175:diagnosis* / Q000601:surgery; D019540:Area Under Curve; D005260:Female; D006801:Humans; D007958:Leukocyte Count; D007962:Leukocytes; D008297:Male; D009504:Neutrophils; D011237:Predictive Value of Tests; D012372:ROC Curve; D012680:Sensitivity and Specificity; D055815:Young Adult