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Combined Diagnostic Accuracy of Total Leukocyte Count, Neutrophil Count, and Ultrasonography for the Diagnosis of Acute Appendicitis

Acute appendicitis is a common surgical emergency that classically presents with right lower abdominal pain and tenderness on palpation. The diagnosis is often based on clinical examination in order to avoid the complications of surgery delay, yielding a high rate of negative appendectomies. Ultraso...

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Autores principales: Fatima, Shehzadi Rimsha, Zaheer, Farhan, Moosa, Foad Ali, Arqam, Shehanshah Muhammed, Mussab, Raja Muhammad, Choudhry, Muhammad Saad
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7932557/
https://www.ncbi.nlm.nih.gov/pubmed/33680626
http://dx.doi.org/10.7759/cureus.13086
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author Fatima, Shehzadi Rimsha
Zaheer, Farhan
Moosa, Foad Ali
Arqam, Shehanshah Muhammed
Mussab, Raja Muhammad
Choudhry, Muhammad Saad
author_facet Fatima, Shehzadi Rimsha
Zaheer, Farhan
Moosa, Foad Ali
Arqam, Shehanshah Muhammed
Mussab, Raja Muhammad
Choudhry, Muhammad Saad
author_sort Fatima, Shehzadi Rimsha
collection PubMed
description Acute appendicitis is a common surgical emergency that classically presents with right lower abdominal pain and tenderness on palpation. The diagnosis is often based on clinical examination in order to avoid the complications of surgery delay, yielding a high rate of negative appendectomies. Ultrasonography is a regularly used modality for establishing the diagnosis, whereas abdominal computed tomography (CT) is often used in sonologically equivocal cases. Other parameters include total leukocyte count, granulocytes, C-reactive protein (CRP), leukocyte elastase activity, D-lactate, phospholipase A2, and interleukin-6 (IL-6). We conducted a prospective study to assess the combined accuracy of total leukocyte count, neutrophil count, and ultrasound as an integrated diagnostic tool. The results of these investigations were tabulated and compared to histopathological evidence of acute appendicitis on biopsy (taken as the gold standard) to calculate sensitivity, specificity, positive predictive value, and negative predictive value. Combined sensitivity and specificity were calculated using cross-tabulation, whereas diagnostic accuracy was estimated from the receiver operating curve (ROC) at the optimal cut-off point. The results showed that the absence of inflammatory findings on ultrasound and normal blood parameters (total leukocyte count and neutrophil count) have a high combined diagnostic accuracy and appendicitis may be ruled out.
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spelling pubmed-79325572021-03-05 Combined Diagnostic Accuracy of Total Leukocyte Count, Neutrophil Count, and Ultrasonography for the Diagnosis of Acute Appendicitis Fatima, Shehzadi Rimsha Zaheer, Farhan Moosa, Foad Ali Arqam, Shehanshah Muhammed Mussab, Raja Muhammad Choudhry, Muhammad Saad Cureus Gastroenterology Acute appendicitis is a common surgical emergency that classically presents with right lower abdominal pain and tenderness on palpation. The diagnosis is often based on clinical examination in order to avoid the complications of surgery delay, yielding a high rate of negative appendectomies. Ultrasonography is a regularly used modality for establishing the diagnosis, whereas abdominal computed tomography (CT) is often used in sonologically equivocal cases. Other parameters include total leukocyte count, granulocytes, C-reactive protein (CRP), leukocyte elastase activity, D-lactate, phospholipase A2, and interleukin-6 (IL-6). We conducted a prospective study to assess the combined accuracy of total leukocyte count, neutrophil count, and ultrasound as an integrated diagnostic tool. The results of these investigations were tabulated and compared to histopathological evidence of acute appendicitis on biopsy (taken as the gold standard) to calculate sensitivity, specificity, positive predictive value, and negative predictive value. Combined sensitivity and specificity were calculated using cross-tabulation, whereas diagnostic accuracy was estimated from the receiver operating curve (ROC) at the optimal cut-off point. The results showed that the absence of inflammatory findings on ultrasound and normal blood parameters (total leukocyte count and neutrophil count) have a high combined diagnostic accuracy and appendicitis may be ruled out. Cureus 2021-02-02 /pmc/articles/PMC7932557/ /pubmed/33680626 http://dx.doi.org/10.7759/cureus.13086 Text en Copyright © 2021, Fatima et al. http://creativecommons.org/licenses/by/3.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Gastroenterology
Fatima, Shehzadi Rimsha
Zaheer, Farhan
Moosa, Foad Ali
Arqam, Shehanshah Muhammed
Mussab, Raja Muhammad
Choudhry, Muhammad Saad
Combined Diagnostic Accuracy of Total Leukocyte Count, Neutrophil Count, and Ultrasonography for the Diagnosis of Acute Appendicitis
title Combined Diagnostic Accuracy of Total Leukocyte Count, Neutrophil Count, and Ultrasonography for the Diagnosis of Acute Appendicitis
title_full Combined Diagnostic Accuracy of Total Leukocyte Count, Neutrophil Count, and Ultrasonography for the Diagnosis of Acute Appendicitis
title_fullStr Combined Diagnostic Accuracy of Total Leukocyte Count, Neutrophil Count, and Ultrasonography for the Diagnosis of Acute Appendicitis
title_full_unstemmed Combined Diagnostic Accuracy of Total Leukocyte Count, Neutrophil Count, and Ultrasonography for the Diagnosis of Acute Appendicitis
title_short Combined Diagnostic Accuracy of Total Leukocyte Count, Neutrophil Count, and Ultrasonography for the Diagnosis of Acute Appendicitis
title_sort combined diagnostic accuracy of total leukocyte count, neutrophil count, and ultrasonography for the diagnosis of acute appendicitis
topic Gastroenterology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7932557/
https://www.ncbi.nlm.nih.gov/pubmed/33680626
http://dx.doi.org/10.7759/cureus.13086
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