Appendicitis is a disease that continues to be characterized by a high morbidity rate that has changed little over the past 50 years. A significant proportion of patients (39 percent in this study) still present with advanced disease (gangrene, perforation, or abscess), as determined at operation. Duration of symptoms was the factor most closely associated with advanced disease. Patients with advanced disease had 88 percent of the morbidity. Primary care physicians referred patients who had symptoms for a longer period of time and who ultimately were found to have a more advanced stage of disease compared with patients who were referred from emergency rooms. This difference did not correlate with third party insurance coverage, as both referral groups exhibited a similar profile of coverage. In this study, the number of normal appendices removed was 5 percent. Early intervention remains the most promising means to reduce morbidity, mortality, and discomfort for the child and expense to the family or insurance carrier of a child with suspected appendicitis.