ED Pathway for Evaluation/Treatment of Child
with Suspected Appendicitis
Suspected Appendicitis
Labs
NPO, IVF
Analgesia
Labs
NPO, IVF
Analgesia
Labs
NPO, IVF
Analgesia
Ultrasound
Surgery Consultation
Surgery /Consultation
Diagnosis
of Appendicitis

Admit Surgery / OR
Positive Appendicitis
Concern for
Abscess
Admit Surgery
COMMUNICATION
ED NP/Resident - Surgical Resident
ED Attending - Surgical Fellow
Senior Surgical Eval - 45 minutes
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)
Positive
Secondary
Signs
Negative
Secondary
Signs
Consider
Surgical Consultation
Surgical Fellow/Attending and ED Attending discuss need for Appendicitis MRI
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 > 4 days/ Immunocompromised / Very Ill
Piperacilln/Tazobactam
Consider ID Consult

OR/Inpatient

OR/Inpatient admission criteria:

  • Concern for perforation
  • Systemic infection or concern for Sepsis
  • Concern for underlying condition
  • Complex medical history
EDECU
EDECU admission criteria:
Uncomplicated, non-perforated appendicitis
 
Posted: October 2006
Revised: September 2011, January 2013, February 2015, February 2017, April 2018, July 2018, January 2019,
July 2019 (Reviewed)
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