ED Pathway for Evaluation/Treatment of Child with Suspected Appendicitis

Suspected Appendicitis
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Labs
NPO, IVF
Analgesia
Labs
NPO, IVF
Analgesia
Labs
NPO, IVF
Analgesia
Ultrasound
Surgery Consultation
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Surgery Consultation
Diagnosis
of Appendicitis

Admit Surgery / OR
Positive Appendicitis
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Concern for
Abscess
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Admit Surgery
COMMUNICATION
ED NP/Resident - Surgical Resident
ED Attending - Surgical Fellow
Senior Surgical Eval - 45 minutes
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Appendix Not Seen
Appendix Normal
Abdominal CT with IV and oral contrast at 0 and 2 hours
(Stable patients - 1st contrast in ED, study completion after admission)
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Positive
Secondary
Signs
Negative
secondary
signs
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Surgical Consultation
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CT scan request requires
conversation between
ED Attending and
Surgical Fellow/Attending
PO Challenge
Discharge
Admit Med

Pre-Operative Antibiotics Indicated for All Patients with Appendicitis
(Non-Perforated/Unknown, Perforated, Abscess)

Non-Allergic Healthy Patients
Ceftriaxone/Metronidazole

Cephalosporin Allergy
Ciprofloxacin/Metronidazole

Recent Hospitalization > 4days/ Immunocompromised / Very Ill Piperacillin/Tazobactam
Consider ID Consult

Posted: October 2006
Revised: September 2011, January 2013
Authors: J. Lavelle, MD, J. Collins, MD, C. Jacobstein, MD, M.Mittal MD,
M. Joffe, MD, J. Zorc, MD, M. Nance, MD, K. Darge, MD, K. Young, RN, D. Albert, RN