Keskek Mehmet, Tez Mesut, Yoldas Omer, Acar Atahan, Akgul Ozgur, Gocmen Erdal, Koc Mahmut
Fifth Department of Surgery, Ankara Numune Training and Research Hospital, 06500 Ankara, Turkey.
Am J Emerg Med. 2008 Sep;26(7):769-72. doi: 10.1016/j.ajem.2007.10.036.
There has been no clear-cut value of the white blood cell (WBC) count in differential diagnosis of acute appendicitis in emergency medicine. Therefore, the aim of this study was to assess the preoperative WBC counts in 3 groups of patients operated on for a clinical suspicion of acute appendicitis with different findings at appendectomy: uninflamed appendix, uncomplicated acute appendicitis, or complicated acute appendicitis.
The medical records of 540 patients who underwent appendectomy for suspected acute appendicitis during a 17-month period were retrospectively reviewed. Data for 3 groups of patients were analyzed to calculate the sensitivity and specificity of the WBC count in the diagnosis of acute appendicitis, and we calculated likelihood ratios for 2 cut-points with either high sensitivity or high specificity. Receiver operating characteristic curves were used to evaluate the WBC count in relation to the true diagnosis and severity of acute appendicitis.
We were able to identify patients with appendicitis on a statistically significant level using receiver operating characteristic curves of WBC counts (area under the curve = 0.756, P < .001), but the WBC count had no diagnostic value in differentiating between uncomplicated and complicated groups (area under the curve = 0.55, P = .086). Likelihood ratio ranged from 1.79 (95% confidence interval, 1.17-2.3) for WBC count of more than 10,500 cells/mm(3) to 3.20 (95% confidence interval, 2.72-3.24) for WBC count of more than 14,300 cells/mm(3).
White blood cell count is helpful in the diagnosis and exclusion of appendicitis. However, there is no value to differentiate advanced appendicitis.
在急诊医学中，白细胞（WBC）计数在急性阑尾炎的鉴别诊断中尚无明确价值。因此，本研究旨在评估三组因临床怀疑急性阑尾炎而接受手术的患者术前的白细胞计数，这些患者在阑尾切除术中具有不同的发现：阑尾未发炎、单纯性急性阑尾炎或复杂性急性阑尾炎。
回顾性分析了540例在17个月期间因疑似急性阑尾炎接受阑尾切除术的患者的病历。分析三组患者的数据，以计算白细胞计数在急性阑尾炎诊断中的敏感性和特异性，并计算两个具有高敏感性或高特异性切点的似然比。采用受试者工作特征曲线来评估白细胞计数与急性阑尾炎的真实诊断和严重程度的关系。
我们能够使用白细胞计数的受试者工作特征曲线在统计学显著水平上识别阑尾炎患者（曲线下面积 = 0.756，P <.001），但白细胞计数在区分单纯性和复杂性组方面没有诊断价值（曲线下面积 = 0.55，P =.086）。似然比范围从白细胞计数超过10,500个细胞/mm³时的1.79（95%置信区间，1.17 - 2.3）到白细胞计数超过14,300个细胞/mm³时的3.20（95%置信区间，2.72 - 3.24）。
白细胞计数有助于阑尾炎的诊断和排除。然而，在区分晚期阑尾炎方面没有价值。
