Appendicitis Clinical Pathway — Emergency Department
Clinical Appendicitis Scores
Experienced physician's clinical impression is comparable to these scores.
Pediatric Appendicitis Risk Calculator
- Age, sex, temperature, nausea and/or vomiting
- Pain duration, pain location, pain with walking, pain migration, guarding
- WBC and ANC
The pARC uses the following variables:
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 |
|
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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 |
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Absence of maximal tenderness in RLQ or RLQ tenderness w/o pain on walking, jumping or coughing |
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