Friday, January 3, 2014

Using the White Blood Cell Count to Reduce Negative Appendectomies: A Retrospective Study

Yesterday, we blogged about using a clinical pathway to predict suspected appendicitis, and today, we continue our discussion of appendicitis and ways to minimize negative appendectomies.

While surgeons may tell you they need to operate on a presumptive appendix even if that appendix may not be inflamed, so as not to miss a potential perforation, they will also want to minimize the negative appendectomy rate. Yet how can they do this?

Bates et al. (doi: 10.1542/peds.2013-2418) decided to see if the magnitude of the white blood cell count (in this case a lower one) could defer surgery and increase observation before automatically operating on a child with a presumptive acute abdomen. The authors did a retrospective review of all appendectomies performed over a 42 month period of time and looked at pre-op lab and radiographic data for all patients in this study. The authors compared this data for normal and abnormal appendices and found normal white blood cell counts (below 8,000 - 9,000) meant a reduction in negative appendectomies.

Just how much of a reduction requires you to cut into this study and decide how much you trust the results to stop surgery or at least observe longer in the setting of a low- normal white blood cell count.

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