Appendicitis Clinical Pathway — Emergency Department

Clinical Appendicitis Scores

Experienced physician's clinical impression is comparable to these scores.

Pediatric Appendicitis Risk Calculator

    The pARC uses the following variables:

  • Age, sex, temperature, nausea and/or vomiting
  • Pain duration, pain location, pain with walking, pain migration, guarding
  • WBC and ANC
  • pARC: Pediatric Appendicitis Risk Calculator  

Reference:

Development and Validation of a Novel Pediatric Appendicitis Risk Calculator (pARC)

The Pediatric Appendicitis Score

Pediatric Appendicitis Score (PAS)
Low Risk < 4; High Risk ≥ 7
Nausea/vomiting 1
Anorexia 1
Migration of pain to RLQ 1
Fever 1
Cough/percussion/hopping tenderness 2
RLQ tenderness 2
Leucocytosis (WBC > 10,000) 1
Neutrophilia (ANC > 7,500) 1
Low Risk PAS < 3        High Risk PAS > 7        Indeterminate Risk        PAS 4-6

Low Risk Appendicitis Score

Refined Low Risk Appendicitis Score
Absence of maximal tenderness in RLQ     or
RLQ tenderness w/o pain on walking, jumping or coughing
and
ANC < 6750/mm3
NPV 95% for identifying children without appendicitis

Kharband AB, Dudley NC, Bajaj L et al. Validation and refinement of a prediction rule to identify children at low risk for acute appendicitis. Arch Pediatr Adolesc Med 2012:166;738