Pop! goes the appendix

Perforation is more likely in younger kids because:
1. More thin walled appendix, predisposing to early perforation
2. Younger children can’t communicate as well, resulting in prolonged symptoms before diagnosis
3. The level of suspicion for appendicitis is lower in younger age groups

Pro-Tip: In addition, appendicitis can progress to peritonitis quicker in infants, because they have a less well developed omentum, and thus cannot contain infection as well.

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