Could a White Blood Cell Cutoff Reduce Negative Appendectomy Rates in Children?

To identify clinical predictors of negative pediatric appendectomies, investigators retrospectively reviewed charts for 847 children (median age, 13 years) who underwent surgery at a tertiary children's hospital for suspected appendicitis from 2009 to 2012. Of 22 children (2.6%) with negative appendectomies, 19 underwent ultrasonography, computed tomography imaging, or both. Findings were appendicolith only (2 patients), appendix not visualized (3), tip enlarged or inflamed (5), inconclusive (2), enlarged appendix with focal inflammation (5), and normal visualized appendix (2).

Using a white blood cell (WBC) count cutoff of >9000/µL for predicting appendicitis would have yielded a sensitivity of 92% and reduced the negative appendectomy rate…