Childhood appendicitis in the United Kingdom: fifty years of progress

The number of in-hospital deaths in children aged 0 to 14 years from acute appendicitis in England and Wales has fallen from an annual average of 36.2 in 1963 through 1967 to 1.8 in 1993 through 1997, and the case-fatality rate from 1.06 to 0.16 per 1,000 discharges, a reduction of 85%. During these 4 decades, the child population has fallen by 8.5%, and the number of children discharged from the hospital with a diagnosis of acute appendicitis by 63%. These data highlight a trend noted in Scotland in the first 50 years of the 20th century. Approximately three quarters of the fall in the number of deaths from acute appendicitis since 1963 is accounted for by a lower incidence of appendicitis in a slightly reduced child population. A quarter of the fall is caused by a marked decline in the hospital case-fatality rate during the last 30 years, likely to be related to improvements in clinical care. Delay in diagnosis is the main contributory factor in the residual small number of deaths each year. Despite the availability of numerous diagnostic aids, clinical acumen remains a fundamental component of expert management of acute appendicitis in children.