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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Consider
Surgical Consultation
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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

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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
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