Pediatric Appendicitis Score

Pediatric Appendicitis Score

(1 point) anorexia

(1 point) fever

(1 point) nausea/vomiting

(1 point) migration of pain

(2 points) pain with cough, percussion, or hopping

(2 points) RLQ tenderness

(1 point) Leukocytosis (WBC > 10,000)

(1 point) Left shift (ANC >6750)

• 10 point scale incorporating history, physical and lab components
• Initial study (Samuels, 2002) with N = 1170
• Prospective cohort age 4-15 with abdominal pain suggestive of appendicitis
• Cutoff of >=6 provides 1.00 sensitivity and 0.92 specificity
• Logistic regression to determine best fit of diagnostic variables for sum of true-positive and true-negative results (total joint probability for a single cutoff)

• Validation studies have shown better performance at the ends of the spectrum (using 2 cutoffs)
• Validated prospectively and retrospectivelyIn ages > 1
• Using various combinations of cutpoints
• 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
• Use of the PAS would have decreased the need for imaging