II. Indications

  1. Appendicitis evaluation in children

III. Criteria

  1. Score 2: Right lower quadrant pain with cough, percussion or hopping
  2. Score 2: Right lower quadrant tenderness on light palpation
  3. Score 1: Anorexia
  4. Score 1: Low grade fever over 38 C (100.4 F)
  5. Score 1: Nausea or Vomiting
  6. Score 1: Leukocytosis (>10,000/mm3)
  7. Score 1: Left Shift (>75% Neutrophilia)
  8. Score 1: Migration of pain to the Right Lower Quadrant

IV. Interpretation

  1. Score 1-3: Low risk of Appendicitis
  2. Score 4-7: Intermediate risk of Appendicitis
  3. Score 8-10: High risk of Appendicitis

V. Efficacy

  1. Pediatric Appendicitis Score (PAS) alone
    1. Test Sensitivity: 80%
    2. Test Specificity: 70%
  2. Pediatric Appendicitis Score AND Appendix Ultrasound (if intermediate risk PAS)
    1. Efficacy is highly operator dependent in Appendix Ultrasound
    2. Test Sensitivity: 92%
    3. Test Specificity: 95%

VI. Precautions

  1. Not sufficiently sensitive or specific for Appendicitis to be used as sole tool for Appendicitis evaluation
  2. Consider using this Pediatric Appendicitis Score (PAS) in combination with Appendix Ultrasound
    1. PAS 1-3: Discharge home with 24 hour follow-up
    2. PAS 4-7: Appendix Ultrasound
      1. Appendix Ultrasound negative: Discharge home with 24 hour follow-up
      2. Appendix Ultrasound positive: Surgical Consultation
    3. PAS 8-10: Surgical Consultation

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