The Value Of Combination Of Serum C-reactive Protein,Leukocyte Count,Neutrophil Count And CT Scan In Diagnosis Of Acute Appendicitis

Background:The most common cause of acute abdomen in surgery department is acute appendicitis and the most commonly done emergency surgery is appendicectomy.Accurate diagnosis relies on careful history,physical examination,laboratory and imaging investigations.Despite several investigation modalities,the accuracy of the diagnosis of acute appendicitis remains challenging.The sensitivity and specificity of a single test is not reliable and satisfactory.Common investigations for the diagnosis of acute appendicitis are WBC count,Neutrophil count,and serum CRP level.OBJECTIVES:The purpose of this study was to assess the role of few well known and proven investigations for acute appendicitis like WBC,Neutrophil,and CRP.This study also assesses the sensitivity and specificity of the same investigations when combined together in same patient to improve the diagnostic accuracy.Methods:A prospective study was conducted on 100 patients of acute appendicitis who have been diagnosed clinically and posted for appendicectomy in Surgery department of The first affiliated hospital of Dali University for a period of 2years（from 2018 January to 2019 December）.All patients included in this study had satisfied the inclusion and exclusion criteria after obtaining proper ethical clearance.During the initial visit preoperatively blood sample were taken for investigations such as WBC count,Neutrophil count,and serum CRP level.Histopathological examination was done postoperatively for all the patients,which was taken as gold standard.The results of WBC count,Neutrophil count and CRP level were correlated with result of Histopathological examination to evaluate their role in diagnosing acute appendicitis.Results:In my study serum CRP（88%）,shows highest sensitivity followed by WBC count（75%）and Neutrophil count（78%）.Sensitivity is increased when CRP and WBC are combined together（98%）.Combining all the four tests together the result shows significant increase in the sensitivity of the tests,which also increases the accuracy in diagnosing acute appendicitis.It also shows that when all these tests are negative,appendicitis could be ruled out safely and surgery can be deferred.Conclusion:Serum CRP level seems to be one of the most important diagnostic investigations;therefore,it should always be included in diagnostic criteria of acute appendicitis.Although WBC count and Neutrophil count’s sensitivity seems to be low individually but its sensitivity increases significantly when combined together with CRP.CT scan seems to be useful in establishing alternative diagnosis but its availability,feasibility and limitation of use should be kept in mind.Diagnostic accuracy seems to be increased significantly when all these investigations are combined together.Although a surgeon can diagnose acute appendicitis with proper history and clinical examination,the investigations are used to complement the clinical diagnosis and not replace it.