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Suspected Appendicitis Clinical Pathway – Emergency Department

Emergency Department Clinical Pathway for Evaluation/Treatment
of Children with Suspected Appendicitis

 
 
 
 
 
 
  • Reassuring H&P
  • Able to tolerate PO
  • Alternative diagnosis probable
  • Labs as indicated
  • Treat as clinically indicated
  • Discharge, follow-up
 
 
 
 
Appendicitis: High-Probability
Classic features of appendicitis
Appendicitis: Equivocal
Some features of appendicitis
  • Obtain Laboratory Studies
    • CBC, CRP, UA POC, BMP
    • HCG as clinically indicated
  • NPO, IVF, analgesia as indicated
  • Males, Pre-Pubertal Females
  • Post-Pubertal Females
    • Obtain Laboratory Studies
      • CBC, CRP, BMP, HCG,
        UA POC after imaging
    • NPO, IVF, analgesia as indicated
    • Instruct child not to urinate
    • Consider STI testing
 
 
 
 
 
 
Appendicitis
Appendix Not Seen
Appendix Normal
 
 
 
 
 
 
 
 
  • Consult General Surgery
  • IV Antibiotics
  • Restore intravascular volume
    • NS bolus, maintenance fluids
  • Surgical team to decide treatment plan
  • Secondary Signs
    • MRI appendix
  • No Secondary Signs
    • Consider alternative diagnoses
    • Review lab results
    • Review PAS, pARC  
    • Consider MR based on risk
    • Consider US Pelvis with Doppler
    • Surgical consult as indicated
  • Reassess PE, PO challenge
  • Consider alternative diagnosis
  • Further evaluation as indicated
    • Concern for ovarian pathology continue with bladder filling and add US Pelvis with Doppler
Positive
 
 
 
 
 
 
 
 
Disposition
Disposition
 
 
 
 
 
 
 
 
OR/PACU
Admit
Discharge
Admit
Most children with non-perforated appendicitis don't require admission following surgery and go home same day
Instructions for follow-up in
24 hrs if symptoms progress
As indicated

 

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