Approach to children with suspected appendicitis

ANC: absolute neutrophil count; C: Centigrade; CRP: C-reative protein; F: Fahrenheit; PAS: Pediatric Appendicitis Score; RLQ: right lower quadrant; US: ultrasonography; WBC: white blood cell count.

* Classic signs of appendicitis consist of abdominal pain for less than 2 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.

¶ Applies to patients with a similar constellation of findings with or without use of another clinical prediction rule.

Δ For patients with a moderate risk of appendicitis based upon the Pediatric Appendicitis Score or a similar constellation of findings with or without the use of another clinical prediction rule, diagnostic imaging prior to surgical consultation is typically performed. We prefer US. 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. Refer to UpToDate content on appendicitis in children: diagnostic imaging.