ED Pathway for Evaluation/Treatment of Child with Suspected Appendicitis

Complete History and Physical

Onset of symptoms  
Pain Duration, location, migration
Severity (use pain scale score)
Worse on walking (Evidence of
peritoneal irritation)
Anorexia/Nausea Last good meal
Oral intake since symptom onset
Fluid intake, urine output
Vomiting Time of onset (before or after
abdominal pain), last episode
Number of episodes
Bilious / bloody
Stool Time of last stool
Diarrhea, blood / mucous
Fever Duration
Medications given
Other associated symptoms  
Past Medical History Prior abdominal pain episodes
Physical Examination
General Appearance, VS  
Abdomen Focal tenderness, guarding/rebound
psoas, obdurator, Rovsing signs
CVA tenderness
Genital Tanner stage
Inguinal canal abnormality/hernia
Scrotum/testicles abnormalities
Bimanual exam, as indicated
Rectal exam, as indicated