Acute appendicitis: the continuing role for active observation

We present the results of a 6-year review of appendicitis. In the event of diagnostic doubt, a policy of active observation was instituted. This revie w endorses the validity of such a policy, indicating that it does not expos e patients to increased morbidity. Data were collected prospectively over a 6-year period on 1,479 children admitted with suspected acute appendicitis (AA); 1,028 (69.5%) were discharged with a diagnosis of non-specific abdom inal pain after a mean observation period of 2.5 days, whilst in the remain ing 451 a clinical diagnosis of AA was confirmed. The male-to-female ratio was equal, with no difference in the mean age of males (11 years) or female s (12 years); 95% of patients were over the age of 5 years. In 324 (72%) ca ses surgery was performed on the day of admission, whilst in the remaining 126 (28%) it was deferred for 1 to 6 days because the clinical diagnosis of AA remained doubtful. The mean hospital stay was 4 days (range 1 - 32). An alysis of the histological reports of all 451 cases confirmed a positive pr edictive Value for clinical assessment alone of 97.9% and a normal appendic ectomy rate of 2.6%. No mortality was observed; surgical morbidity was reco rded at 6% with no correlation between postoperative morbidity and timing o f surgery evident (Spearmans correlation coefficient =-0.079, p=0.9). Activ e observation for suspected AA thus remains a valid technique for achieving an accurate diagnosis and successful outcome.