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Clinical and laboratory findings in acute appendicitis in the elderly
1Department of Family and Community Medicine, University of Kansas School of Medicine, Wichita 67214-3199, USA.
Background:
Early diagnosis and surgery are important factors by which the morbidity and mortality of acute appendicitis in elderly patients can be lowered. This study was conducted to determine clinical and laboratory results that are commonly associated with acute appendicitis in elderly patients.
Methods:
A retrospective chart review was conducted of patients aged 60 years or older who underwent appendectomy or laparotomy for suspected acute appendicitis during a 5-year period in a metropolitan county. Acute appendicitis was confirmed by the pathology report.
Results:
Elevated band cells and right lower quadrant pain were predictors of acute appendicitis in clinically suspected cases. Band cells greater than 6 percent had an excellent positive predictive value, as all patients with elevated band cells had acute appendicitis. With increasing white cell count and temperature, specificity increased, sensitivity decreased, and the positive predictive value remained high.
Conclusions:
It is essential to have a high degree of suspicion to recognize acute appendicitis in an afebrile elderly patient who has abdominal pain, a mildly elevated white cell count, and band cells in the upper limits of normal.