Appendicitis: factors that influence the frequency of perforation.

The mortality from perforating appendicitis has decreased, but the incidence of perforation has not changed in 30 years. We found that among 335 consecutive patients treated for acute appendicitis, 108 (32%) had evidence of perforation. No significant differences between the groups were noted with respect to race, sex, educational level, family income, health insurance coverage, availability of transportation, and possession of a telephone. Perforation was more likely in patients who lived more than 20 miles from the hospital and in patients under age 10 years or over age 60. Patients with perforation were ill for a mean of 2.5 days before seeking medical attention, compared to a mean of 1.5 days for those without perforation (P < .001). Yet, approximately 75% of patients in each group stated that they had a "family doctor." Patients with perforation had significantly more physician visits before hospital admission (mean 1.61 vs 1.33, P < .005); 54.3% of patients with perforation had previous contact with a physician who failed to make the correct diagnosis.