E-ISSN 2146-8133
 

Original Research 


Does a Negative Triple Test Reduce the Rate of Negative Appendectomy in Adults?

Mahmoud F. Sakr, Hossam M. Hamed, Hisham M. Al-Torky.

Abstract
Objectives: To investigate the negative predictive value (NPV) of the triple test (total leukocyte count [TLC], neutrophil percentage [NP], and C-reactive protein [CRP] level) in the diagnostic accuracy of acute appendicitis by reducing negative appendectomy rates (NARs) in adult patients.
Methods: The present prospective clinical study included 348 consecutive patients admitted to Ahmadi Hospital, Kuwait during 2010 and 2011 with the possible diagnosis of acute appendicitis. Children (<16 years) (n=61) and pregnant women (n=5) were excluded. The remaining 282 patients were enrolled but only those with an NTT (n=102) were analyzed (study population). The NTT meant TLC <11,000/µL, NP <75%, and CRP <5 mg/L. The data collected included demographics, clinical presentation, laboratory tests, histopathology, and outcome, and the NPV was calculated.
Results: Sixty-seven patients (65.9%) were female and 35 (34.1%) were male. Their ages ranged between 16 and 49 years (mean 27.5 years). Most patients (87.3%) had their symptoms for 12-36 hours before hospital admission. The mean values for TLC, NP, and CRP were 7,573/µL, 54.53%, and 0.61 mg/L, respectively. Of the 102 patients with NTT, 101 (99%) proved not to have appendiceal inflammation (NPV=99%). Only 39 patients were operated upon, of whom 38 (97.4%) had a normal appendix, and the remaining 63 patients were either discharged (n=47) or referred to other specialties (n=16). There were significantly more women (76.3%, 29/38) with negative appendectomy than men (24.7%, 9/38) (X2= 21.1, p=0.0001). Gynecological causes were the most common (60.5%, 23/38) and in 11 cases, the exact etiology could not be identified.
Conclusions: From the data presented, it may be concluded that TLC, NP and CRP blood levels (triple test) should be measured upon hospital admission of adult patients with clinically suspected acute appendicitis. If used judiciously, they may spare the group of patients with an NTT an unnecessary surgical operation, hence markedly reducing the NAR with its potential risks.

Key words: Acute appendicitis, leukocytic count, neutrophils, C-reactive protein, triple test 


 
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How to Cite this Article
Pubmed Style

Mahmoud F. Sakr, Hossam M. Hamed, Hisham M. Al-Torky. Does a Negative Triple Test Reduce the Rate of Negative Appendectomy in Adults?. Arch Clin Exp Surg. 2012; 1(4): 229-236. doi:10.5455/aces.20120416074153


Web Style

Mahmoud F. Sakr, Hossam M. Hamed, Hisham M. Al-Torky. Does a Negative Triple Test Reduce the Rate of Negative Appendectomy in Adults?. http://www.ejmaces.com/?mno=18042 [Access: November 14, 2018]. doi:10.5455/aces.20120416074153


AMA (American Medical Association) Style

Mahmoud F. Sakr, Hossam M. Hamed, Hisham M. Al-Torky. Does a Negative Triple Test Reduce the Rate of Negative Appendectomy in Adults?. Arch Clin Exp Surg. 2012; 1(4): 229-236. doi:10.5455/aces.20120416074153



Vancouver/ICMJE Style

Mahmoud F. Sakr, Hossam M. Hamed, Hisham M. Al-Torky. Does a Negative Triple Test Reduce the Rate of Negative Appendectomy in Adults?. Arch Clin Exp Surg. (2012), [cited November 14, 2018]; 1(4): 229-236. doi:10.5455/aces.20120416074153



Harvard Style

Mahmoud F. Sakr, Hossam M. Hamed, Hisham M. Al-Torky (2012) Does a Negative Triple Test Reduce the Rate of Negative Appendectomy in Adults?. Arch Clin Exp Surg, 1 (4), 229-236. doi:10.5455/aces.20120416074153



Turabian Style

Mahmoud F. Sakr, Hossam M. Hamed, Hisham M. Al-Torky. 2012. Does a Negative Triple Test Reduce the Rate of Negative Appendectomy in Adults?. Archives of Clinical and Experimental Surgery (ACES), 1 (4), 229-236. doi:10.5455/aces.20120416074153



Chicago Style

Mahmoud F. Sakr, Hossam M. Hamed, Hisham M. Al-Torky. "Does a Negative Triple Test Reduce the Rate of Negative Appendectomy in Adults?." Archives of Clinical and Experimental Surgery (ACES) 1 (2012), 229-236. doi:10.5455/aces.20120416074153



MLA (The Modern Language Association) Style

Mahmoud F. Sakr, Hossam M. Hamed, Hisham M. Al-Torky. "Does a Negative Triple Test Reduce the Rate of Negative Appendectomy in Adults?." Archives of Clinical and Experimental Surgery (ACES) 1.4 (2012), 229-236. Print. doi:10.5455/aces.20120416074153



APA (American Psychological Association) Style

Mahmoud F. Sakr, Hossam M. Hamed, Hisham M. Al-Torky (2012) Does a Negative Triple Test Reduce the Rate of Negative Appendectomy in Adults?. Archives of Clinical and Experimental Surgery (ACES), 1 (4), 229-236. doi:10.5455/aces.20120416074153





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