Emergency Department Clinical Pathway for Evaluation/Treatment
of Children with Suspected Appendicitis
ED Team Assessment
- 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
Classic features of appendicitis
Appendicitis: Equivocal
Some features of appendicitis
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
- Consider Laboratory Studies
- CBC, CRP, UA POC, BMP
- IVF, analgesia as indicated
- Consider Laboratory Studies
- Post-Pubertal Females
- Obtain Laboratory Studies
- CBC, CRP, BMP, HCG,
UA POC after imaging
- CBC, CRP, BMP, HCG,
- NPO, IVF, analgesia as indicated
- Instruct child not to urinate
- Consider STI testing
- Obtain Laboratory Studies
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
- 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
24 hrs if symptoms progress
As indicated
Evidence
- IDSA 2024 Guideline Update on the Risk Assessment, Diagnostic Imaging, and Microbiological Evaluation of Complicated Intra-Abdominal Infections in Adults, Children, and Pregnant People
- Validation and Refinement of a Prediction Rule to Identify Children at Low Risk for Acute Appendicitis
- Development and Validation of a Novel Pediatric Appendicitis Risk Calculator (pARC)