Ulus Travma Acil Cerrahi Derg. 2015; 21(2): 102-106 | DOI: 10.5505/tjtes.2015.29626

Total Leukocyte and Neutrophil count as preventive tools in reducing negative appendectomies

Muhammad Salman Rafiq, Mah Muneer Khan, Ataullah Khan, Bilal Ahmad
Surgical Department, Khyber Teaching Hospital, Peshawar, Pakistan.

Background:
Negative appendectomies result in unnecessary admissions, health care burden and cost. This study was conducted to assess Total leukocyte and Neutrophil counts as preventive tools in reducing negative appendectomies.
Methods:
Data of admitted patients who underwent appendectomies was analyzed. Receiver operator characteristic (ROC) curve analysis of Total Leukocyte and Neutrophil Counts was calculated for various cut-off points. Optimum sensitivity, specificity, over-all accuracy and area under the curve was determined.
Results:
Of the 408 total patients, true and negative appendicitis by operative assessment was 294(72.1%) and 114(27.9%) compared to 311(76.2%) and 97(23.8%) by histopathology, respectively. Optimal cut-off for Total Leukocyte Count was >11.9x109/Liter with 87.14% sensitivity and 91.75% specificity. Optimal cut-off point for Neutrophil Count was >7.735x109/Liter with 98.71% sensitivity and 91.75% specificity. Area under the curve for Total Leukocyte and Neutrophil Counts was 0.9603 and 0.9872, respectively with overall accuracy of 91.2% and 97.1%, respectively.
Conclusion:
Normal Total Leukocyte and Neutrophil counts strongly associate with negative appendectomies. Non-operative measures and careful observation for Total Leukocyte and Neutrophil Counts <11.9x109/Liter and <7.735x109/Liter, respectively can reduce the negative appendectomy rate. In cases with normal values of these, a trial period can be given if the condition allows.

Keywords: Acute, Appendicitis, Leukocyte Count, Neutrophils, Negative appendectomy, ROC curve.

---

Total lökosit ve nötrofil sayýsý negatif apandektomilerin azaltýlmasýný saðlayan belirteçlerdir

Muhammad Salman Rafiq, Mah Muneer Khan, Ataullah Khan, Bilal Ahmad
Khyber Eðitim Hastanesi, Cerrahi Kliniði, Peþaver, Pakistan

AMAÇ: Negatif apandektomiler gereksiz hasta kabullerine neden olarak, saðlýk hizmetlerine yük ve mali külfet getirmektedir. Bu çalýþma, negatif apendektomilerin azaltýlmasýnda total lökosit ve nötrofil sayýlarýný deðerlendirmek üzere yürütüldü.
GEREÇ VE YÖNTEM: Hastaneye kabul edilen ve apandektomi geçiren hastalarýn verileri incelendi. Deðiþik kestirim noktalarý için total lökosit ve nötrofil sayýlarýnýn alýcý iþletim karakteristik eðrisi (ROC) analizi hesaplandý. Optimal duyarlýlýk, özgüllük, genel doðruluk derecesi ve eðrisi altýnda kalan alan belirlendi.
BULGULAR: Toplam 408 hastada cerrahi deðerlendirmeye göre gerçek ve negatif apandisit oranlarý %72.1 (n=294) ve %27.9 (n=114) iken histopatolojik olarak bu oranlar sýrasýyla %76.2 (n=311) ve %23.8 (n=97) idi. Total lökosit sayýmýnýn optimal kestirim deðeri olan >11.9x109/L, %87.14 duyarlýlýk ve %91.75 özgüllüðe sahipti. Total nötrofil sayýsýnýn optimal kestirim deðeri olan >7.735x109/L %98.71 duyarlýlýk ve %91.75 özgüllüðe sahipti. Total lökosit ve nötrofil sayýlarý için eðri sýrasýyla 0.9603 ve 0.9872 olup, genel doðruluk oranlarý sýrasýyla %91.2 ve 97.1 idi.
TARTIÞMA: Normal total lökosit ve nötrofil sayýlarý negatif apandektomilerle kuvvetle iliþkilidir. Cerrahi dýþý önlemler, toplam lökosit ve nötrofil sayýlarý dikkatli klinik takip oldukça önemlidir.

Anahtar Kelimeler: Akut, apandisit; lökosit sayýsý; negatif apandektomi; nötrofiller; ROC eðrisi.

---

CITE