Acute appendicitis in childhood: A statistical study of 848 cases from the Children's Hospital, Boston

Abstract

Summary An analysis of experience in the Boston Children's Hospital with 848 children suffering from acute appendicitis and its complications is presented. The possible correlation of appendicitis with respiratory tract infection is considered, but statistical proof of correlation is not demonstrated. Oxyuris vermicularis infestation as a cause of acute inflammation is infrequent, but there appears to be a clinical syndrome indistinguishable, with safety, from appendicitis produced by such infestation. The role of fecal concretions in producing extreme inflammatory changes in the inflamed appendix is reported, but there is no definite evidence that the fecalith initiates the inflammation. The symptoms, signs, and changes in the peripheral blood are sufficiently consistent to make diagnosis before perforation possible even in the very young. It is essential that the triad of abdominal pain, vomiting, and slight fever be considered presumptive evidence of acute appendicitis and that frequent, gentle, and painstaking examinations be made during the first twelve hours of illness to corroborate or disprove such a diagnosis. The plan of treatment employed is described and a favorable mortality experience (3.06 per cent) reported. Factors affecting the mortality rate are, in the order of their importance, (1) the type of appendicitis present at the time of admission, which in turn is governed by the duration of the attack before diagnosis and the age of the patient, (2) the treatment employed, (3) coexistent disease, and (4) the age of the patient. There need be no inherently high mortality rate based on age alone provided that a diagnosis is made comparably early to the diagnosis in adult life and provided that the young patient is treated wisely. There is some ground for encouragement in the fact that between 1934 and 1938 40 per cent of the patients were admitted with peritoneal complications as opposed to 47 per cent between 1929 and 1933, and that the death rate was 2.3 per cent in the last half of the ten-year period as compared with 3.6 per cent in the first half. During 1938 there were 92 patients treated, 37.8 per cent with peritoneal complications, and there were no deaths. Figures are presented which demonstrate the continuing need for lay education and, to a lesser extent, for re-emphasizing the problem to the medical profession.