Appendicitis Clinical Pathway — Emergency Department

Clinical Appendicitis Scores

Experienced physician's clinical impression is comparable to these scores.

Pediatric Appendicitis Risk Calculator

The pARC uses the following variables:

Age, sex, temperature, nausea and/or vomiting
Pain duration, pain location, pain with walking, pain migration, guarding
WBC and ANC

pARC: Pediatric Appendicitis Risk Calculator

Reference:

Kharbanda AB, Vazquez-Benitez G, Ballard DW et al. Development and validation of a novel Pediatric Appendicitis Risk Calculator (pARC). Pediatr 2018:141:4

The Pediatric Appendicitis Score

Pediatric Appendicitis Score (PAS) Low Risk < 4; High Risk ≥ 7
Nausea/vomiting	1
Anorexia	1
Migration of pain to RLQ	1
Fever	1
Cough/percussion/hopping tenderness	2
RLQ tenderness	2
Leucocytosis (WBC > 10,000)	1
Neutrophilia (ANC > 7,500)	1
Low Risk PAS < 3 High Risk PAS > 7 Indeterminate Risk PAS 4-6

Low Risk Appendicitis Score

Refined Low Risk Appendicitis Score
Absence of maximal tenderness in RLQ or RLQ tenderness w/o pain on walking, jumping or coughing and ANC < 6750/mm3
NPV 95% for identifying children without appendicitis

Kharband AB, Dudley NC, Bajaj L et al. Validation and refinement of a prediction rule to identify children at low risk for acute appendicitis. Arch Pediatr Adolesc Med 2012:166;738

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

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