II. Indications
- Appendicitis evaluation in children
III. Criteria
- Score 2: Right lower quadrant pain with cough, percussion or hopping
- Score 2: Right lower quadrant tenderness on light palpation
- Score 1: Anorexia
- Score 1: Low grade fever over 38 C (100.4 F)
- Score 1: Nausea or Vomiting
- Score 1: Leukocytosis (>10,000/mm3)
- Score 1: Left Shift (>75% Neutrophilia)
- Score 1: Migration of pain to the Right Lower Quadrant
IV. Interpretation
- Score 1-3: Low risk of Appendicitis
- Score 4-7: Intermediate risk of Appendicitis
- Score 8-10: High risk of Appendicitis
V. Efficacy
- Pediatric Appendicitis Score (PAS) alone
- Test Sensitivity: 80%
- Test Specificity: 70%
- Pediatric Appendicitis Score AND Appendix Ultrasound (if intermediate risk PAS)
- Efficacy is highly operator dependent in Appendix Ultrasound
- Test Sensitivity: 92%
- Test Specificity: 95%
VI. Precautions
- Not sufficiently sensitive or specific for Appendicitis to be used as sole tool for Appendicitis evaluation
- Consider using this Pediatric Appendicitis Score (PAS) in combination with Appendix Ultrasound
- PAS 1-3: Discharge home with 24 hour follow-up
- PAS 4-7: Appendix Ultrasound
- Appendix Ultrasound negative: Discharge home with 24 hour follow-up
- Appendix Ultrasound positive: Surgical Consultation
- PAS 8-10: Surgical Consultation