WHITE BLOOD-CELL COUNT IS A POOR PREDICTOR OF SEVERITY OF DISEASE IN THE DIAGNOSIS OF APPENDICITIS

The white blood cell (WBC) count is considered to be a useful test in the diagnosis of appendicitis. The purpose of this study was to examin e the clinical features of patients with normal WBC appendicitis and a lso to determine whether a higher WBC count correlates with a more adv anced stage of appendicitis. Patients with pathologically confirmed ap pendicitis from January 1989 to December 1994 were included in the stu dy (n = 1919). The age, gender, temperature, length of hospital stay, and severity of disease (1 = acute appendicitis; 2 = gangrenous append icitis; 3 = perforated appendicitis with abscess formation; 4 = append icitis with diffuse peritonitis) were compared for patients with a nor mal WBC count (range, 3.8-10.9) versus those who had an elevated WBC c ount. A normal WBC count was seen in 11 per cent of patients (n = 209) . There was no difference in age, temperature, gender, or severity of disease in the patients with a normal WBC count compared with those wi th an elevated WBC count (P > 0.05). The severity of disease of patien ts with a normal WBC count were: 1 = 58 per cent; 2 = 13 per cent; 3 = 7 per cent; and 4 = 22 per cent. For patients with an elevated WBC co unt the scores were: 1 = 57 per cent; 2 = 17 per cent; 3 = 13 per cent ; and 4 = 14 per cent. The proportion of gangrenous and perforated app endicitis in the patients with a normal WBC count is the same as in th e patients with an elevated WBC count.