ED Pathway for Evaluation/Treatment of Child with Suspected Appendicitis

Complete History and Physical

History
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