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What Is the Gold Standard?

James R. Elmore, MD; Albert W. Dibbins, MD; Michael R. Curci, MD

Arch Surg. 1987;122(4):424-427.

Abstract
• From 1976 to 1985, 233 consecutive children were treated for appendicitis by a standardized protocol. Forty-nine percent of these cases were complicated: 11% by gangrene, 33% by perforation, and 4% by perforations with well-developed abscesses. Treatment of gangrenous and perforated appendicitis consisted of administration of ampicillin sodium, gentamicin sulfate, and clindamycin phosphate; appendectomy; and saline peritoneal irrigation. Transperitoneal drainage was not used. Skin and subcutaneous tissues were left open for delayed primary wound closure. Perforations with well-developed abscesses were treated with triple antibiotic therapy and interval appendectomy. The only infectious complication was one intra-abdominal abscess. There were no wound infections or deaths. The rate of infectious complications was 0.9%, and the overall morbidity was 4.4%. This standardized treatment of complicated appendicitis in children prevents wound infection and significantly decreases the incidence of intra-abdominal abscess formation and mortality.

(Arch Surg 1987;122:424-427)

Author Affiliations
From the Department of Surgery, Maine Medical Center, Portland.

Footnotes
Accepted for publication Dec 30, 1986.

Read before the 67th Annual Meeting of the New England Surgical Society, Dixville Notch, NH, Sept 26, 1986.

Reprint requests to Department of Surgery, Maine Medical Center, 22 Bramhall St, Portland, ME 04102 (Dr Elmore).

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