Lowering the threshold of white blood cells (WBC) to the range of 8,000 per µL to 9,000 per µL as a diagnostic criterion for appendicitis can reduce the rates of negative appendectomies (NA) in children to less than 1 percent, according to a study published in the January issue of Pediatrics. While maximum sensitivity has always been emphasized in diagnosis of appendicitis, given the significant negative consequences associated with a missed case of true appendicitis, the national rate of NA remains over 3 percent in the United States. Given the commonness of appendicitis, this NA rate indicates a large number of unnecessary surgeries, which do carry some risks to children. In an effort to further decrease the false-positive rate associated with appendectomies, researchers retrospectively reviewed all appendectomies performed for suspected appendicitis at a tertiary children’s hospital over a 42-month period with regard to preoperative clinical, laboratory, and radiographic data. Over the study period, 847 appendectomies were performed with 2.6 percent (n=22) having a pathologically normal appendix, or NA. WBC count and neutrophil count were found to be normal in more than three-quarters of the NAs (89 percent and 79 percent, respectively). Applying WBC cutoffs of 9,000 per µL and 8,000 […]