C-reactive protein and white blood cell count do not improve clinical decision-making in acute appendicitis

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Resumé

INTRODUCTION: Acute appendicitis (AA) remains a diagnostic challenge as indicated by the high rate of unnecessary surgery. Blood samples, primarily C-reactive protein (CRP) and leucocyte counts, are used as a diagnostic supplement despite their relatively low sensitivities and specificities. However, their influence on diagnostic decision-making has not previously been investigated. The aim of the present study was to investigate if the results of CRP and leucocytes had any positive or negative influence on the decision-making of surgeons handling patients with suspected AA. METHODS: This was a prospective, observational cohort study including patients (>= 15 years of age) admitted on suspicion of AA. The surgeons were instructed to perform their physical examination and to register whether they found the patient more or less than 50% likely to have AA. Thereafter, the surgeons had to assess the blood results and re-evaluate their diagnosis. The surgeon's diagnosis before and after was compared with the final diagnosis defined by surgical findings or follow-up. The gold standard was any degree of appendicitis on histology. RESULTS: A total of 226 patients were included of whom 91 (40.3%) had appendicitis on histology. The surgeons changed their diagnosis in nine cases after assessing blood samples. The changes in the proportion of correct diagnoses, sensitivity, specificity and predictive values after assessing blood samples were not significant. CONCLUSIONS: The results of CRP and leucocyte counts did not influence clinical decision-making.
OriginalsprogEngelsk
ArtikelnummerA5167
TidsskriftDanish Medical Journal
Vol/bind62
Udgave nummer12
Antal sider4
ISSN2245-1919
StatusUdgivet - 2015

Bibliografisk note

Danish Council for Independent Research [12-132020] 0 A5167

Emneord

  • SUSPECTED ACUTE APPENDICITIS SURGICAL-CARE STATES

Citer dette

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title = "C-reactive protein and white blood cell count do not improve clinical decision-making in acute appendicitis",
abstract = "INTRODUCTION: Acute appendicitis (AA) remains a diagnostic challenge as indicated by the high rate of unnecessary surgery. Blood samples, primarily C-reactive protein (CRP) and leucocyte counts, are used as a diagnostic supplement despite their relatively low sensitivities and specificities. However, their influence on diagnostic decision-making has not previously been investigated. The aim of the present study was to investigate if the results of CRP and leucocytes had any positive or negative influence on the decision-making of surgeons handling patients with suspected AA. METHODS: This was a prospective, observational cohort study including patients (>= 15 years of age) admitted on suspicion of AA. The surgeons were instructed to perform their physical examination and to register whether they found the patient more or less than 50{\%} likely to have AA. Thereafter, the surgeons had to assess the blood results and re-evaluate their diagnosis. The surgeon's diagnosis before and after was compared with the final diagnosis defined by surgical findings or follow-up. The gold standard was any degree of appendicitis on histology. RESULTS: A total of 226 patients were included of whom 91 (40.3{\%}) had appendicitis on histology. The surgeons changed their diagnosis in nine cases after assessing blood samples. The changes in the proportion of correct diagnoses, sensitivity, specificity and predictive values after assessing blood samples were not significant. CONCLUSIONS: The results of CRP and leucocyte counts did not influence clinical decision-making.",
keywords = "SUSPECTED ACUTE APPENDICITIS SURGICAL-CARE STATES",
author = "Sofie Tind and Lassen, {Annmarie Touborg} and Erik Zimmermann-Nielsen and N. Qvist",
note = "Danish Council for Independent Research [12-132020] 0 A5167",
year = "2015",
language = "English",
volume = "62",
journal = "Danish Medical Journal",
issn = "1603-9629",
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}

C-reactive protein and white blood cell count do not improve clinical decision-making in acute appendicitis. / Tind, Sofie; Lassen, Annmarie Touborg; Zimmermann-Nielsen, Erik; Qvist, N.

I: Danish Medical Journal, Bind 62, Nr. 12, A5167, 2015.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

TY - JOUR

T1 - C-reactive protein and white blood cell count do not improve clinical decision-making in acute appendicitis

AU - Tind, Sofie

AU - Lassen, Annmarie Touborg

AU - Zimmermann-Nielsen, Erik

AU - Qvist, N.

N1 - Danish Council for Independent Research [12-132020] 0 A5167

PY - 2015

Y1 - 2015

N2 - INTRODUCTION: Acute appendicitis (AA) remains a diagnostic challenge as indicated by the high rate of unnecessary surgery. Blood samples, primarily C-reactive protein (CRP) and leucocyte counts, are used as a diagnostic supplement despite their relatively low sensitivities and specificities. However, their influence on diagnostic decision-making has not previously been investigated. The aim of the present study was to investigate if the results of CRP and leucocytes had any positive or negative influence on the decision-making of surgeons handling patients with suspected AA. METHODS: This was a prospective, observational cohort study including patients (>= 15 years of age) admitted on suspicion of AA. The surgeons were instructed to perform their physical examination and to register whether they found the patient more or less than 50% likely to have AA. Thereafter, the surgeons had to assess the blood results and re-evaluate their diagnosis. The surgeon's diagnosis before and after was compared with the final diagnosis defined by surgical findings or follow-up. The gold standard was any degree of appendicitis on histology. RESULTS: A total of 226 patients were included of whom 91 (40.3%) had appendicitis on histology. The surgeons changed their diagnosis in nine cases after assessing blood samples. The changes in the proportion of correct diagnoses, sensitivity, specificity and predictive values after assessing blood samples were not significant. CONCLUSIONS: The results of CRP and leucocyte counts did not influence clinical decision-making.

AB - INTRODUCTION: Acute appendicitis (AA) remains a diagnostic challenge as indicated by the high rate of unnecessary surgery. Blood samples, primarily C-reactive protein (CRP) and leucocyte counts, are used as a diagnostic supplement despite their relatively low sensitivities and specificities. However, their influence on diagnostic decision-making has not previously been investigated. The aim of the present study was to investigate if the results of CRP and leucocytes had any positive or negative influence on the decision-making of surgeons handling patients with suspected AA. METHODS: This was a prospective, observational cohort study including patients (>= 15 years of age) admitted on suspicion of AA. The surgeons were instructed to perform their physical examination and to register whether they found the patient more or less than 50% likely to have AA. Thereafter, the surgeons had to assess the blood results and re-evaluate their diagnosis. The surgeon's diagnosis before and after was compared with the final diagnosis defined by surgical findings or follow-up. The gold standard was any degree of appendicitis on histology. RESULTS: A total of 226 patients were included of whom 91 (40.3%) had appendicitis on histology. The surgeons changed their diagnosis in nine cases after assessing blood samples. The changes in the proportion of correct diagnoses, sensitivity, specificity and predictive values after assessing blood samples were not significant. CONCLUSIONS: The results of CRP and leucocyte counts did not influence clinical decision-making.

KW - SUSPECTED ACUTE APPENDICITIS SURGICAL-CARE STATES

M3 - Journal article

VL - 62

JO - Danish Medical Journal

JF - Danish Medical Journal

SN - 1603-9629

IS - 12

M1 - A5167

ER -