Appendicitis Clinical Pathway — Emergency Department

Probability of Appendicitis

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

High Probability
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

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

Accordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Children’s Hospital of Philadelphia (“CHOP”), its physicians and the individual patients in question. CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. CHOP is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient.