Pediatric Appendicitis Score (PAS)
Use for patients 3-18 years of age.
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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.
- Jamie Lovell, MD