Pediatric Appendicitis Score (PAS)

For patients who are not low risk, next steps include NPO status, IV fluids, analgesia, and imaging or surgical consultation.

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.

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.