[column col=”1/2″]What is the Pediatric Appendicitis Score for the following patient? What does this score say about their risk of acute appendicitis? Does he need further testing to confirm the diagnosis?

A 7 year old male presents with 18 hours of abdominal pain that was initially periumbilical, but moved to the right lower quadrant. He is not hungry – at all. He has vomited 3 times. He is afebrile. On exam he has pain with hopping, and with deep palpation in the right lower quadrant. You have yet to obtain any labs.

To the right are the scoring criteria.

The answers are at the end of the post.[/column]

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Pediatric Appendicitis Score

1 anorexia
1 fever
1 nausea/vomiting
1 migration of pain
2 pain with cough, percussion, or hopping
2 RLQ tenderness
1 Leukocytosis (WBC > 10,000)
1 Left shift (ANC >6750)[/column]

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Key points

  • 10 point scale incorporating history, physical and lab components
  • Initial study Prospective cohort age 4-15 with abdominal pain suggestive of appendicitis with N = 1170 (Samuels, 2002)
    • Cutoff of >=6 provides 1.00 sensitivity and 0.92 specificity
  • Prospective and retrospective validation studies have shown better performance at the ends of the spectrum (using 2 cutoffs), and have been done for patients ages 1-21 years
  • High risk scores (> 7) had a specificity of 95-98%
  • Low risk scores (<3) had a negative predictive value of 98%
  • Moderate risk scores indicated the need for further imaging


His PAS is 7, even before labs. The specificity of this score is >95% – that is your ability to rule in appy on history and exam alone is quite high. It wouldn’t be unreasonable to treat his pain and consult surgery directly. The benefit of labs or imaging aren’t as great with this high of a score.