Pediatric Appendicitis Risk Calculator (pARC)
Quantifies appendicitis risk in pediatric patients with abdominal pain, possibly better than the Pediatric Appendicitis Score.
Use in children ≥5 years old presenting to the emergency department or outpatient setting with acute abdominal pain (duration <96 hours).
Specificity of this calculator for cases determined to be at highest risk of appendicitis (pARC Score >85%) was 99.7%; specificity was 97.5% for cases in the high-intermediate range (pARC Score 75-84%).
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Children determined by the calculator to be low risk for appendicitis can be considered candidates for safe discharge or observation in the emergency room without advanced imaging such as ultrasound or CT, depending upon provider discretion and family comfort.
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Given the specificity of the calculator, children classified as high or high-intermediate risk for appendicitis may not need advanced imaging. 1.2% of appendectomy specimens in the high risk group were negative for appendicitis on pathology analysis. In the high-intermediate risk group, 2.6% of specimens were pathology-negative.
Critically ill children, or children with emergent “surgical abdomens” (rigidity, visible ecchymosis or hematoma, etc) should not be considered for delayed surgical consultation or imaging. Those children will likely benefit from early involvement of pediatric surgeons as well as imaging when able to be transported to radiology.