Appendicitis Clinical Pathway — Emergency Department Probability of Appendicitis High Probability Symptoms < 48 hours Migration of pain from periumbilical to RLQ Progressive symptoms Anorexia, nausea, vomiting Pain preceding vomiting Pain with movement Cough, car ride, jumping on right foot RLQ tenderness with or without rebound Equivocal Focal abdominal tenderness (usually right-sided) Some of the features of High Probability acute appendicitis present Low Probability Few signs for appendicitis Reassess for alternative diagnosis