Diagnostic approach to pediatric appendicitis

PAS: Pediatric Appendicitis Score; WBC: white blood cell count; ANC: absolute neutrophil count; CRP: C-reative protein; RLQ: right lower quadrant.
* Classic signs of early appendicitis consist of abdominal pain for less than two days that begins periumbilically and then begins to radiate and localize to the right lower quadrant. The pain is associated with anorexia, vomiting, and low grade fever. RLQ tenderness is present on physical examination and the white blood cell count, absolute neutrophil count, and/or c-reactive protein are elevated.
¶ For components of the pediatric appendicitis score refer to UpToDate graphics on pediatric appendicitis score and to the UpToDate topic on clinical manifestations and diagnosis of appendicitis in children.
Δ Diagnostic imaging prior to surgical consultation is typically performed for these patients. For specific discussion of which imaging tests to order, refer to UpToDate topics on diagnostic imaging in pediatric appendicitis. If local resources are insufficient to adequately perform or interpret pediatric diagnostic imaging or if surgeons with pediatric expertise are not available, the patient should be transferred to a facility with pediatric radiologic and surgical capability and no imaging should be performed at the local institution.