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. 2020 Nov-Dec;34(6):3327-3339.
doi: 10.21873/invivo.12171.

Leucocyte Count Does Not Improve the Diagnostic Performance of a Diagnostic Score (DS) in Distinguishing Acute Appendicitis (AA) from Nonspecific Abdominal Pain (NSAP)

Jannica Meklin #  1 , Maaret Eskelinen #  1 , Kari Syrjanen  2   3 , Matti Eskelinen  4
Affiliations

Leucocyte Count Does Not Improve the Diagnostic Performance of a Diagnostic Score (DS) in Distinguishing Acute Appendicitis (AA) from Nonspecific Abdominal Pain (NSAP)

Jannica Meklin et al. In Vivo. 2020 Nov-Dec.

Abstract

Background/aim: Although, acute appendicitis (AA) and nonspecific abdominal pain (NSAP) are the most common diagnoses among secondary care patients with acute abdominal pain, the diagnostic performance of leucocyte count (LC) in DS (Diagnostic Score) model is rarely considered.

Patients and methods: As an extension of the World Organisation of Gastro-Enterology Research Committee (OMGE) acute abdominal pain study, 1,333 patients presenting with acute abdominal pain were included in the study. The clinical history and diagnostic symptoms (n=22), signs (n=14) and tests (n=3) in each patient were recorded in detail, and the collected data were related with the final diagnoses of the patients.

Results: In the ROC comparison test, there was no statistically significant difference in the performance of DSLC- (DS without LC) and DSLC+ (DS with LC). The highest sensitivities of the DSLC- and DSLC+ tests for detecting AA were 86% (95%CI=81-90%) and 87% (95%CI=82-91%), respectively. The highest specificities of the DSLC- and DSLC+ tests for detecting AA were 98% (95%CI=97-99%) and 98% (95%CI=96-99%), respectively.

Conclusion: DS could assist the clinician in differentiating AA from NSAP and other causes of acute abdominal pain. Importantly, LC does not improve the diagnostic performance of a DS in AA.

Keywords: Acute appendicitis; HSROC; ROC; diagnostic score; leucocyte count; non-specific abdominal pain.

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Conflict of interest statement

The Authors report no conflicts of interest or financial ties in relation to this study. The Authors alone are responsible for the content and writing of this article.

Figures

Figure 1
Figure 1. Pooled sensitivities of the clinical symptoms in acute appendicitis (random-effects model). ES: Estimated sensitivity; CI: confidence interval.
Figure 2
Figure 2. Pooled specificities of the clinical symptoms in acute appendicitis (random-effects model). ES: Estimated sensitivity; CI: confidence interval.
Figure 3
Figure 3. Pooled sensitivities of the clinical signs and tests in acute appendicitis (random-effects model). ES: Estimated sensitivity; CI: confidence interval.
Figure 4
Figure 4. Pooled sensitivities of the clinical signs and tests in acute appendicitis (random-effects model). ES: Estimated sensitivity; CI: confidence interval.
Figure 5
Figure 5. Sensitivities of diagnostic scores without leucocyte count (DSLC–) shown as six different combination of symptoms, signs and test.
Figure 6
Figure 6. Specificities of diagnostic scores without leucocyte count (DSLC–) shown as six different combination of symptoms, signs and test.
Figure 7
Figure 7. Sensitivities of diagnostic scores with leucocyte count (DSLC+) shown as six different combinations of symptoms, signs and test.
Figure 8
Figure 8. Specificities of diagnostic scores with leucocyte count (DSLC+) shown as six different combinations of symptoms, signs and tests.
Figure 9
Figure 9. Hierarchical summary receiver operating characteristic (HSROC) curve of the clinical symptoms
Figure 10
Figure 10. Hierarchical summary receiver operating characteristic (HSROC) and Empirical Bayes curves of the clinical symptoms.
Figure 11
Figure 11. Hierarchical summary receiver operating characteristic (HSROC) curve of the clinical signs and tests.
Figure 12
Figure 12. Hierarchical summary receiver operating characteristic (HSROC) and Empirical Bayes curves of the clinical signs and tests
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