• Anshuman Sengupta, George Bax, and Simon Paterson-Brown.
• Department of General Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK. anshusengupta@doctors.org.uk
• Ann R Coll Surg Engl. 2009 Mar 1; 91 (2): 113-5.

IntroductionClinical assessment outweighs the use of investigations in the diagnosis of acute appendicitis. Nevertheless, white cell count (WCC) and C-reactive protein (CRP) are regularly measured in patients with suspected appendicitis. The aim of this study was to assess the utility of these markers in patients presenting with acute lower abdominal pain.Patients And MethodsWCC and CRP were measured prospectively in 98 patients presenting with lower abdominal pain, and the results were correlated with each patient's outcome.ResultsNo patients with WCC and CRP both in the normal range had acute appendicitis. Raised WCC and CRP were poor positive predictors of appendicitis, both alone and in combination, and correlated poorly with the development of complications.ConclusionsThis result may have important clinical and economic implications. We suggest that patients experiencing lower abdominal pain, with normal WCC and CRP values, are unlikely to have acute appendicitis and can be safely sent home.

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