Pediatric Appendicitis Score (PAS)
Why Use
The Pediatric Appendicitis Score has been validated in multicenter studies. The PAS may be as good as clinician gestalt at identifying patients at low risk for appendicitis versus those with appendicitis.
When to Use
Children or adolescents with acute abdominal pain, especially localized to the right lower quadrant (RLQ), where appendicitis is suspected.
Formula
Pearls / Pitfalls
The Pediatric Appendicitis Score (PAS) predicts likelihood of appendicitis in pediatric patients (3-18 years old) with abdominal pain of ≤4 days duration. Stratifies patients into low risk, high risk, or equivocal for appendicitis. Includes findings from history, physical, and lab data. Should NOT be used in patients with known GI disease, pregnancy, or previous abdominal surgeries.
Management
Low Risk PAS (<4) Low likelihood of acute appendicitis, and likely do not warrant imaging. The score has a higher negative predictive value (95%) in the absence of RLQ pain, pain with walking/jumping or coughing, and an ANC <6,750. Consider other causes of acute abdominal pain. Equivocal PAS (4-6) Imaging can be helpful for this subgroup of patients, preferably ultrasound or MRI for pediatric patients. Surgical consults are warranted for patients with equivocal scores and imaging where the appendix cannot be visualized. High Risk PAS (>6) Surgical consult is warranted for these patients. Imaging may still be pursued, but patients should only undergo ultrasound prior to a surgical consult.
Critical Actions
Patients in the low risk group according to the PAS do not have a zero risk. Use clinical discretion if imaging or surgical consult may aid in diagnosis.
Advice
For patients who are not low risk, next steps include NPO status, IV fluids, analgesia, and imaging or surgical consultation.
More Information
Variable Points Right lower quadrant (RLQ) tenderness to cough, percussion, or hopping 2 Anorexia 1 Fever (temp ≥38.0ºC/100.4ºF) 1 Nausea or vomiting 1 Tenderness over right iliac fossa 2 Leukocytosis (WBC ≥10,000) 1 Neutrophilia ( ANC >7,500) 1 Migration of pain to RLQ 1