Title: role of total leukocyte count, neutrophil percentage, C-reactive protein and ultrasonography in the diagnosis of acute appendicitis

Total leucocyte count (TLC), neutrophil percentage (NP), C-reactive protein (CRP) and ultrasonographic (USG) examination of the abdomen were studied prospectively in 197 patients who underwent appendectomy for suspected appendicitis. On histopathological study of the resected appendices, only 176 patients had acutely inflamed, perforated or gangrenous appendices. The sensitivity, specificity and predictive value of single tests and test combinations were calculated using standard reference intervals. CRP demonstrated the best sensitivity (89%) followed by ultrasonography (78%), though the best specificity (90.47%) was observed in the latter test. The sensitivity decreased when raised TLC, NP, CRP and suggestive USG were used together to predict appendicitis but the specificity increased markedly (95%) indicating the fact that acute appendicitis is unlikely when all these tests are simultaneously negative. Early USG, preferably combined with CRP, and leucocyte counts is a very useful diagnostic aid in acute appendicitis and clinicians should suspect that appendicitis is less likely if all four investigations are simultaneously negative.
Introduction Acute appendicitis is one of the most frequent causes of acute abdomen in nearly all age groups (1) and hence appendectomy is one of the most common surgeries being [...]