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Three Part Question

In [pregnant women with a clinical diagnosis of appendicitis] is [a raised white cell count] useful in [diagnosis]?

Clinical Scenario

A 27 year old woman who is 14 weeks pregnant, presents to the emergency department with the symptoms and signs of appendicitis. You refer the case to the acute surgical team who ask you to obtain a white cell count. You wonder whether this test has any value in this situation.

Search Strategy

Medline 1966-05/00 using the OVID interface.
({exp appendicitis OR acute appendicitis.mp} AND {exp hematological tests OR exp leucocyte count OR leucocyte count$.mp OR neutrophil count$.mp OR white cell count$.mp OR inflammatory parameter$.mp OR white blood count$.mp} AND exp pregnancy OR exp pregnancy abdominal OR exp pregnancy complications OR pregnancy.mp) LIMIT to human AND english.

Search Outcome

9 papers found of which 5 were irrelevant and 2 of insufficient quality for inclusion. The remaining 2 papers are shown in the table.

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Doberneck RC, 1985, USA	29 pregnant women undergoing appendectomy.	Retrospective survey	WCC > 10,000	Sensitivity 85%; Specificity 33%; Positive likelihood ratio 1.28; Negative likelihood ratio 0.45	Retrospective selection bias. Women undergoing appendectomy only. Small numbers. Incomplete data.
			WCC > 15,000	Sensitivity 50%; Specificity 89%; Positive likelihood ratio 4.5; Negative likelihood ratio 0.56
Anderson B and Nielsen TF, 1999, Sweden	56 pregnant women undergoing appendectomy.	Retrospective survey	WCC > 16,000	Sensitivity 60%; Specificity 5%; Positive likelihood ratio 0.63; Negative likelihood ratio 8.4	Retrospective selection bias. Women undergoing appendectomy only. Small numbers. Incomplete data.

Comment(s)

The only available studies deal with the wrong spectrum of patients. The women included all underwent appendicectomy; this is a selected sample of pregnant women presenting to emergency departments with the clinical signs and symptoms of appendicitis.

Clinical Bottom Line

There is no evidence to support the use of isolated white cell counts in the diagnosis of acute appendicitis in pregnant women.

References

1. Doberneck RC. Appendectomy during pregnancy Am Surg 1985;51:265-8.
2. Andersen B and Nielsen TF Appendicitis during pregnancy: Diagnosis, management and complications Arch Obstet Gynecol Scand 1999;78:758-62.