Use of White Blood Cell Count and Polymorphonuclear Leukocyte Differential to Improve the Predictive Value of Ultrasound for Suspected Appendicitis in.

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Use of White Blood Cell Count and Polymorphonuclear Leukocyte Differential to Improve the Predictive Value of Ultrasound for Suspected Appendicitis in Children Seema P. Anandalwar, MD, Michael J. Callahan, MD, Richard G. Bachur, MD, Christina Feng, MD, Feroze Sidhwa, MD, Mahima Karki, BA, George A. Taylor, MD, Shawn J. Rangel, MD, MSCE, FACS Journal of the American College of Surgeons Volume 220, Issue 6, Pages 1010-1017 (June 2015) DOI: 10.1016/j.jamcollsurg.2015.01.039 Copyright © 2015 American College of Surgeons Terms and Conditions

Figure 1 Assembly of the study cohort. ED, emergency department. Journal of the American College of Surgeons 2015 220, 1010-1017DOI: (10.1016/j.jamcollsurg.2015.01.039) Copyright © 2015 American College of Surgeons Terms and Conditions

Figure 2 Relationships among WBC count, polymorphonuclear leukocyte differential (PMN%), and appendicitis for the 5 most common constellations of ultrasound findings in children with suspected appendicitis. Laboratory thresholds were established for all constellations using WBC >9 × 103/μL + PMN% >65% for positive predictive value and WBC ≤9 × 103/μL + PMN% ≤65% for negative predictive value. Patients confirmed to have pathologically proven appendicitis are represented by black squares and those without appendicitis by gray diamonds. 1Primary signs of appendicitis are hyperemia of appendiceal wall or wall thickness >7 mm. 2Secondary signs of appendicitis are fecalith or echogenic fat. Journal of the American College of Surgeons 2015 220, 1010-1017DOI: (10.1016/j.jamcollsurg.2015.01.039) Copyright © 2015 American College of Surgeons Terms and Conditions