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Laboratory tests in patients with suspected acute appendicitis.

S Eriksson1, L Granström, S Bark

  • 1Department of Surgery, Karolinska Institute, Danderyd Hospital, Sweden.

Acta Chirurgica Scandinavica
|February 1, 1989
PubMed
Summary

This study examined how well three common blood tests can help diagnose acute appendicitis before surgery. Researchers looked at white blood cell counts, differential counts, and C-reactive protein levels in 113 patients who had emergency appendectomies. They found that in all confirmed cases of appendicitis, at least one test was abnormal. However, in patients without appendicitis, all three tests were normal in some cases. The study suggests these tests may help reduce unnecessary surgeries but cannot fully rule out the condition. The authors recommend using these tests alongside clinical judgment rather than relying on them alone.

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Area of Science:

  • Emergency surgery diagnostics
  • Inflammatory disease biomarkers
  • Clinical laboratory medicine

Background:

Accurate diagnosis of acute appendicitis remains challenging in emergency settings. While physical exams and imaging are commonly used, laboratory tests are frequently incorporated to support clinical decisions. Prior research has shown that elevated white blood cell counts and C-reactive protein levels often correlate with inflammation. However, the reliability of these tests in predicting appendicitis has remained unclear. No prior work had resolved how these tests perform in early versus advanced cases. This uncertainty has driven the need for better understanding of their utility in clinical practice. Existing knowledge suggests these tests are not fully specific. The gap motivating this study lies in determining how much these tests can reduce unnecessary surgeries. This paper contributes by analyzing real-world data from a surgical cohort.

Purpose Of The Study:

The aim of this study was to evaluate the clinical usefulness of three laboratory tests in patients suspected of having acute appendicitis. Researchers focused on total and differential white blood cell counts and C-reactive protein levels. They sought to determine how often these tests detect true cases of appendicitis. The specific problem addressed was the high rate of negative appendectomies. The motivation was to assess whether these tests could help avoid unnecessary surgeries. The study aimed to clarify the diagnostic accuracy of these tests in emergency settings. It also sought to examine how test results correlate with disease severity. This analysis aimed to provide evidence for clinical decision-making.

Keywords:
Acute appendicitis diagnosisEmergency surgery testsWhite blood cell countC-reactive proteinNegative appendectomy rate

Frequently Asked Questions

The study found that at least one abnormal test result was present in all confirmed cases of appendicitis, suggesting these tests may help identify true cases.

The study showed abnormal results were most common in advanced stages of inflammation, indicating a possible correlation with disease severity.

No, the study found that in nine out of 27 patients with normal appendices, all three tests were normal, meaning normal results cannot exclude appendicitis.

The differential count was one of three tests analyzed, but the study did not find it more useful than the other two in predicting appendicitis.

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Main Methods:

The study analyzed data from 113 patients who underwent emergency appendectomy for suspected appendicitis. Researchers collected preoperative laboratory results for white blood cell counts, differential counts, and C-reactive protein levels. They compared these results with histopathological findings from the appendix. The sample included patients with and without confirmed appendicitis. Researchers categorized patients based on the stage of inflammation observed in the appendix. They evaluated how frequently abnormal test results occurred in true cases of appendicitis. The team also assessed how often all three tests were normal in patients without appendicitis. This approach allowed them to estimate the potential impact of test results on surgical decisions.

Main Results:

In 86 of the 113 patients, the diagnosis of acute appendicitis was confirmed. At least one abnormal test result was found in all 86 confirmed cases. The highest frequency of abnormal results occurred in advanced stages of inflammation. In 27 patients with normal appendices, all three tests were normal in nine cases. The negative appendectomy rate was 24% in the full cohort. If only patients with normal results in all three tests had been excluded, the rate would have dropped to 16%. These findings suggest that the tests may help reduce unnecessary surgeries. However, they are not fully reliable in ruling out appendicitis.

Conclusions:

The authors stated that preoperative laboratory tests may help identify patients with acute appendicitis. They proposed that abnormal results are more common in advanced cases. The tests may not reliably exclude appendicitis in all patients. The study suggests that these tests could reduce the negative appendectomy rate. However, the authors emphasized that normal results do not guarantee the absence of appendicitis. They concluded that these tests should be used alongside clinical judgment. The findings do not suggest that these tests are essential for diagnosis. The authors did not claim these tests are sufficient on their own.

If only patients with normal results in all three tests had been excluded, the negative appendectomy rate could have dropped from 24% to 16%.

The authors proposed that these tests may help reduce unnecessary surgeries but should be used alongside clinical judgment, not as standalone diagnostic tools.