Normal Total WBC and Operative Delay in Appendicitis

Introduction There are approximately 250,000 cases of appendicitis per year in the United States (I). Delay in diagnosis is associated with an increase risk of perforation and other complications (2) Failure to diagnose appendicitis, or to do so in a timely manner, is a common cause of malpractice litigation and settlements (3,4) The diagnosis of appendicitis remains challenging largely due to the often protean nature of presenting symptoms, variable hislow and physical findings, A d broadli& of non-operative diseases to be considered. Diaenosis remains lareelv deoendent uoon clinical assessment in . . conjunction with a variety of ancillary tests. Historically a comp~ete blood count (CBC) with p&cu~ar focus on white blood count (WBC) has been amone the most commonlv ordered laboratory tests. The data supporting or refuting a role for WBC is highly variable with some studies advocating aiseful role while others sueaestine little utilitv Des~ i te the lack of data suooortine a -.. clear role for WBC in the diagnosis of appendicitis, there is often a . . reluctance to commit to this diagnosis and opewive intervention if thc WBC is normal The obiective of this investieat~on u s 10 determine if a normal total WBC was associated with a delay in operative intervention and, therefore, an increased rate of complications in patients presenting to an ED with a final diagnosis of appendicitis