Revision as of 04:04, 12 March 2011

Pearls

Most common between 6-14 yrs (peak 9y-12y)
Perforation rate up to 92% in children <3 yrs old
Local tenderness + rigidity at McBurney's point is most reliable clinical sign
Analgesia does not delay diagnosis!
NPV of 98% achieved if:
- Lack of nausea (or emesis or anorexia)
- Lack of maximal TTP in the RLQ
- Lack of neutrophil count > 6750

Diagnosis

In children with abdominal pain:

Sx	+LR	-LR
Fever	3.4
Rebound	3.0	0.28
Migration	2.5	1.2
WBC <10k		0.22
ANC <6,750		0.06

==

History & Physical

Neonates (birth - 30 days)
- History
  - Vomiting
  - Irritability/lethargy
- Physical
  - Abdominal distention
Infants (30 days - 2 yrs)
- History
  - Vomiting
  - Abdominal pain
  - Fever
- Physical
  - Diffuse abdominal tenderness
    - Localized RLQ TTP occurs <50%
Preschool (2 - 5yrs)
- History
  - Vomiting (often precedes pain)
  - Abdominal pain
  - Fever
- Physical
  - RLQ tenderness
School-age (6 - 12yrs)
- History
  - Vomiting
  - Abdominal pain
  - Fever
- Physical
  - RLQ tenderness
Adolescents ( >12yrs)
- Present similar to adults
  - RLQ pain
  - Vomiting (occurs after onset of abdominal pain)
  - Anorexia

Laboratory Findings

WBC or neutrophil % elevation
- Sn/Sp = 79/80%
- May also be seen in gastroenteritis, strep, PNA, PID
CRP
- May be more Sn than WBC in identifying perforation
  - Consider in pts with a prolonged history
UA
- 7-25% of pts with appy have sterile pyuria

Imaging

Consider only in intermediate-risk pts
Ultrasound
- Sn: 88%, Sp: 94%
- Consider as 1st choice in non-obese children
CT (+/- contrast)
- Sn: 94%, Sp: 95%
- Consider if U/S is equivocal OR strong suspicion despite normal U/S

Pediatric Appendicitis Score

Anorexia - 1pt
Nausea or vomiting - 1pt
Migration of pain - 1pt
Fever > 100.5 - 1pt
Pain with cough, percussion, or hopping - 2pt
RLQ tenderness - 2pt
WBC > 10K - 1pt
Neutrophils + bands > 7500- 1pt

Score ≤ 2
- Low risk (0-2.5%)
- Consider d/c home with close f/u
Score ≥ 7
- High risk
- Consider surgical consultation
Score 3-6
- Indeterminate risk
- Consider serial exams, consultation, or imaging

Management

Fluids (20 mL/kg boluses)
Analgesia
ABx
- Second gen cephalosporin OR
- Piperacillin/tazobactam OR
- Penicillin allergy?
  - Gent + (clinda or metronidazole)

Differential Diagnosis

Emergent surgical diagnoses
- Bowel obstruction
- Malrotation
- Intussusception
- Ovarian torsion
- Ectopic pregnancy
Emergent nonsurgical diagnoses
- HUS
- DKA
Non-emergent diagnoses
- PID
- PNA
- UTI
- Strep throat
- Gastroenteritis (esp yersinia)

See Also

[/Abdominal-Pain-(Peds) Peds: Abdominal Pain (Peds)]

Source

Bundy DG et al. Does this child have appendicitis? JAMA 2007; 298:438-451, UpToDate

Pearls

Most common between 6-14 yrs (peak 9y-12y)
Perforation rate up to 92% in children <3 yrs old
Local tenderness + rigidity at McBurney's point is most reliable clinical sign
Analgesia does not delay diagnosis!
NPV of 98% achieved if:
Lack of nausea (or emesis or anorexia)
Lack of maximal TTP in the RLQ
Lack of neutrophil count > 6750

Diagnosis

In children with abdominal pain:

Sx +LR -LR Fever 3.4 Rebound 3.0 0.28 Migration 2.5 1.2 WBC <10k 0.22 ANC <6,750 0.06

History & Physical

Neonates (birth - 30 days)
History
Vomiting
Irritability/lethargy
Physical
Abdominal distention
Infants (30 days - 2 yrs)
History
Vomiting
Abdominal pain
Fever
Physical
Diffuse abdominal tenderness
Localized RLQ TTP occurs <50%
Preschool (2 - 5yrs)
History
Vomiting (often precedes pain)
Abdominal pain
Fever
Physical
RLQ tenderness
School-age (6 - 12yrs)
History
Vomiting
Abdominal pain
Fever
Physical
RLQ tenderness
Adolescents ( >12yrs)
Present similar to adults
RLQ pain
Vomiting (occurs after onset of abdominal pain)
Anorexia

Laboratory Findings

WBC or neutrophil % elevation
Sn/Sp = 79/80%
May also be seen in gastroenteritis, strep, PNA, PID
CRP
May be more Sn than WBC in identifying perforation
Consider in pts with a prolonged history
UA
7-25% of pts with appy have sterile pyuria

Imaging

Consider only in intermediate-risk pts
Ultrasound
Sn: 88%, Sp: 94%
Consider as 1st choice in non-obese children
CT (+/- contrast)
Sn: 94%, Sp: 95%
Consider if U/S is equivocal OR strong suspicion despite normal U/S

Pediatric Appendicitis Score

Anorexia - 1pt
Nausea or vomiting - 1pt
Migration of pain - 1pt
Fever > 100.5 - 1pt
Pain with cough, percussion, or hopping - 2pt
RLQ tenderness - 2pt
WBC > 10K - 1pt
Neutrophils + bands > 7500- 1pt
Score ≤ 2
Low risk (0-2.5%)
Consider d/c home with close f/u
Score ≥ 7
High risk
Consider surgical consultation
Score 3-6
Indeterminate risk
Consider serial exams, consultation, or imaging

Management

Fluids (20 mL/kg boluses)
Analgesia
ABx
Second gen cephalosporin OR
Piperacillin/tazobactam OR
Penicillin allergy?
Gent + (clinda or metronidazole)

Differential Diagnosis

Emergent surgical diagnoses
Bowel obstruction
Malrotation
Intussusception
Ovarian torsion
Ectopic pregnancy
Emergent nonsurgical diagnoses
HUS
DKA
Non-emergent diagnoses
PID
PNA
UTI
Strep throat
Gastroenteritis (esp yersinia)

Source

Bundy DG et al. Does this child have appendicitis? JAMA 2007; 298:438-451, UpToDate

Authors:

Appendicitis (peds): Difference between revisions

Revision as of 04:04, 12 March 2011

Contents

Pearls

Diagnosis

==

History & Physical

Laboratory Findings

Imaging

Management

Differential Diagnosis

Source

Appendicitis (Peds)[/rename.php?renamepage=Appendicitis%20%28Peds%29 ]

Page Tools

Insert links

Pearls

Diagnosis

History & Physical

Laboratory Findings

Imaging

Management

Differential Diagnosis

Source

@@ Line 1: / Line 1: @@
-==Pearls==
+== Pearls ==
-* Most common between 6-14 yrs (peak 9y-12y)
+*Most common between 6-14 yrs (peak 9y-12y)
-* Perforation rate up to 92% in children <3 yrs old
+*Perforation rate up to 92% in children <3 yrs old
-* Local tenderness + rigidity at McBurney's point is most reliable clinical sign
+*Local tenderness + rigidity at McBurney's point is most reliable clinical sign
-* Analgesia does not delay diagnosis!
+*Analgesia does not delay diagnosis!
-* NPV of 98% achieved if:
+*NPV of 98% achieved if:
-** Lack of nausea (or emesis or anorexia)
+**Lack of nausea (or emesis or anorexia)
-** Lack of maximal TTP in the RLQ
+**Lack of maximal TTP in the RLQ
-** Lack of neutrophil count > 6750
+**Lack of neutrophil count > 6750
-====
+== Diagnosis ==
-==Diagnosis==
 In children with abdominal pain:
-{| class="pbNotSortable" width="200" cellspacing="1" cellpadding="1"
+{| class="pbNotSortable" cellpadding="1" cellspacing="1" width="200"
+|-
 | Sx
 | +LR
@@ Line 23: / Line 22: @@
 | Fever
 | 3.4
 |
 |-
 | Rebound
@@ Line 34: / Line 33: @@
 |-
 | WBC <10k
 |
 | 0.22
 |-
 | ANC <6,750
 |
 | 0.06
 |}
-====
+= == =
-==History & Physical==
-* '''Neonates (birth - 30 days)'''
-** History
-*** Vomiting
-*** Irritability/lethargy
-** Physical
-*** Abdominal distention
-* '''Infants (30 days - 2 yrs''')
-** History
-*** Vomiting
-*** Abdominal pain
-*** Fever
-** Physical
-*** Diffuse abdominal tenderness
-**** Localized RLQ TTP occurs <50%
-* '''Preschool (2 - 5yrs)'''
-** History
-*** Vomiting (often precedes pain)
-*** Abdominal pain
-*** Fever
-** Physical
-*** RLQ tenderness
-* '''School-age (6 - 12yrs)'''
-** History
-*** Vomiting
-*** Abdominal pain
-*** Fever
-** Physical
-*** RLQ tenderness
-* '''Adolescents ( >12yrs)'''
-** Present similar to adults
-*** RLQ pain
-*** Vomiting (occurs after onset of abdominal pain)
-*** Anorexia
-====
+== History & Physical ==
-==Laboratory Findings==
+*'''Neonates (birth - 30 days)'''
+**History
+***Vomiting
+***Irritability/lethargy
+**Physical
+***Abdominal distention
+*'''Infants (30 days - 2 yrs''')
+**History
+***Vomiting
+***Abdominal pain
+***Fever
+**Physical
+***Diffuse abdominal tenderness
+****Localized RLQ TTP occurs <50%
+*'''Preschool (2 - 5yrs)'''
+**History
+***Vomiting (often precedes pain)
+***Abdominal pain
+***Fever
+**Physical
+***RLQ tenderness
+*'''School-age (6 - 12yrs)'''
+**History
+***Vomiting
+***Abdominal pain
+***Fever
+**Physical
+***RLQ tenderness
+*'''Adolescents ( >12yrs)'''
+**Present similar to adults
+***RLQ pain
+***Vomiting (occurs after onset of abdominal pain)
+***Anorexia
+== Laboratory Findings ==
 <div>
+*WBC or neutrophil&nbsp;% elevation
+**Sn/Sp = 79/80%
+**May also be seen in gastroenteritis, strep, PNA, PID
+*CRP
+**May be more Sn than WBC in identifying perforation
+***Consider in pts with a prolonged history
+*UA
+**7-25% of pts with appy have sterile pyuria
-* WBC or neutrophil % elevation
+== Imaging ==
-** Sn/Sp = 79/80%
-** May also be seen in gastroenteritis, strep, PNA, PID
-* CRP
-** May be more Sn than WBC in identifying perforation
-*** Consider in pts with a prolonged history
-* UA
-** 7-25% of pts with appy have sterile pyuria
-==Imaging==
-* Consider only in intermediate-risk pts
-* Ultrasound
-** Sn: 88%, Sp: 94%
-** Consider as 1st choice in non-obese children
-* CT (+/- contrast)
-** Sn: 94%, Sp: 95%
-** Consider if U/S is equivocal OR strong suspicion despite normal U/S
-<span style="line-height: 21px">'''<font size="17px"><font face="&#39;Segoe UI&#39;, &#39;Lucida Grande&#39;, Arial, sans-serif">Pediatric Appendicitis Score</font></font>'''</span>
+*Consider only in intermediate-risk pts
+*Ultrasound
+**Sn: 88%, Sp: 94%
+**Consider as 1st choice in non-obese children
+*CT (+/- contrast)
+**Sn: 94%, Sp: 95%
+**Consider if U/S is equivocal OR strong suspicion despite normal U/S
-* Anorexia - 1pt
+<span style="line-height: 21px">'''<font size="17px"><font face="'Segoe UI', 'Lucida Grande', Arial, sans-serif">Pediatric Appendicitis Score</font></font>'''</span>
-* Nausea or vomiting - 1pt
-* Migration of pain - 1pt
-* Fever > 100.5 - 1pt
-* Pain with cough, percussion, or hopping - 2pt
-* RLQ tenderness - 2pt
-* WBC > 10K - 1pt
-* Neutrophils + bands > 7500- 1pt
+*Anorexia - 1pt
+*Nausea or vomiting - 1pt
+*Migration of pain - 1pt
+*Fever > 100.5 - 1pt
+*Pain with cough, percussion, or hopping - 2pt
+*RLQ tenderness - 2pt
+*WBC > 10K - 1pt
+*Neutrophils + bands > 7500- 1pt
 </div><div>
+*Score ≤ 2
+**Low risk (0-2.5%)
+**Consider d/c home with close f/u
+*Score ≥ 7
+**High risk
+**Consider surgical consultation
+*Score 3-6
+**Indeterminate risk
+**Consider serial exams, consultation, or imaging
-* Score ≤ 2
+== Management ==
-** Low risk (0-2.5%)
-** Consider d/c home with close f/u
-* Score ≥ 7
-** High risk
-** Consider surgical consultation
-* Score 3-6
-** Indeterminate risk
-** Consider serial exams, consultation, or imaging
-==Management==
-* Fluids (20 mL/kg boluses)
-* Analgesia
-* ABx
-** Second gen cephalosporin OR
-** Piperacillin/tazobactam OR
-** Penicillin allergy?
-*** Gent + (clinda or metronidazole)
-==Differential Diagnosis==
+*Fluids (20 mL/kg boluses)
+*Analgesia
+*ABx
+**Second gen cephalosporin OR
+**Piperacillin/tazobactam OR
+**Penicillin allergy?
+***Gent + (clinda or metronidazole)
-* Emergent surgical diagnoses
+== Differential Diagnosis ==
-** Bowel obstruction
-** Malrotation
-** Intussusception
-** Ovarian torsion
-** Ectopic pregnancy
-* Emergent nonsurgical diagnoses
-** HUS
-** DKA
-* Non-emergent diagnoses
-** PID
-** PNA
-** UTI
-** Strep throat
-** Gastroenteritis (esp yersinia)
-<span style="line-height: 21px">'''<font size="17px"><font face="&#39;Segoe UI&#39;, &#39;Lucida Grande&#39;, Arial, sans-serif">See Also</font></font>'''</span>
+*Emergent surgical diagnoses
+**Bowel obstruction
+**Malrotation
+**Intussusception
+**Ovarian torsion
+**Ectopic pregnancy
+*Emergent nonsurgical diagnoses
+**HUS
+**DKA
+*Non-emergent diagnoses
+**PID
+**PNA
+**UTI
+**Strep throat
+**Gastroenteritis (esp yersinia)
+<span style="line-height: 21px">'''<font size="17px"><font face="'Segoe UI', 'Lucida Grande', Arial, sans-serif">See Also</font></font>'''</span>
 </div>
+[/Abdominal-Pain-(Peds) Peds: Abdominal Pain (Peds)]
-[/Abdominal-Pain-(Peds) Peds:  Abdominal Pain (Peds)]
+== Source ==
-====
-==Source==
 Bundy DG et al. Does this child have appendicitis? JAMA 2007; 298:438-451, UpToDate
 <div id="wikiedit" style="display: none"><div id="editor-panel" class="box">
+= Appendicitis (Peds)[/rename.php?renamepage=Appendicitis%20%28Peds%29 ] =
-=Appendicitis (Peds)[/rename.php?renamepage=Appendicitis%20%28Peds%29  ]=
+{| id="edit-panel" style="table-layout: fixed;  width: 100%"
-{| id="edit-panel" style="table-layout: fixed; width: 100%"
 |-
-|
+| <div id="editframe"></div><div id="edit-toolbar-outer" style="background: none repeat scroll 0% 0% rgb(247, 247, 247);  border-right: 1px solid rgb(221, 221, 221);  border-width: 1px;  border-style: solid;  border-color: rgb(247, 247, 247) rgb(221, 221, 221) rgb(221, 221, 221)"><div id="revcomment_section" style="display: none"><div id="revcomment_top">Describe your changes:[# (hide this)]</div><div class="entry"></div></div><div id="edit-toolbar" class="secondarypagetoolbar"><span id="show_tags" style="float: right;  margin: 5px">Edit tags</span><span id="show_revcomment" style="float: right;  margin: 5px">Describe your changes</span>[#pbedit <span id="saveButton" class="iconbutton savepage">'''Save'''</span>][# <span id="saveAndContinue" class="iconbutton savecontinue" style="position: relative">Save and Continue</span>]<span style="line-height: 30px">or [/w/page/11229287/Appendicitis-(Peds)?unlock=true Cancel]</span></div><div style="clear: both;  line-height: 1px"></div><div id="tag-settings" class="page-settings-panel" style="margin-top: 0.75em;  display: none">
-<div id="editframe"></div><div id="edit-toolbar-outer" style="background: #f7f7f7; border: 1px solid #ddd; border-top: 1px solid #f7f7f7"><div id="revcomment_section" style="display: none"><div id="revcomment_top">Describe your changes:[# (hide this)]</div><div class="entry"></div></div><div id="edit-toolbar" class="secondarypagetoolbar"><span id="show_tags" style="float: right; margin: 5px">Edit tags</span><span id="show_revcomment" style="float: right; margin: 5px">Describe your changes</span><span id="autosave_msg" class="aux"></span>[#pbedit <span id="saveButton" class="iconbutton savepage">'''Save'''</span>][# <span id="saveAndContinue" class="iconbutton savecontinue" style="position: relative">Save and Continue</span>]<span style="line-height: 30px">or [/w/page/11229287/Appendicitis-(Peds)?unlock=true Cancel]</span><span id="save_msg" class="aux loading"></span></div><div style="clear: both; line-height: 1px"><font size="1px"> </font></div><div id="tag-settings" class="page-settings-panel" style="margin-top: 0.75em; display: none">
 {| width="100%"
-| style="width: 4em" |
+|-
+| style="width: 4em" |
 Tags
-|
+|
 e.g. report, new release, planning
 |}
+<div style="clear: both;  line-height: 1px"></div><div id="tagcloud"></div></div></div>
-<div style="clear: both; line-height: 1px"><font size="1px"> </font></div><div id="tagcloud"></div></div></div>
+| <div id="editor-column" class="thingbar" style="margin-left: 12px"><div id="edit-tools">
-|
+==== Page Tools ====
-<div id="editor-column" class="thingbar" style="margin-left: 12px"><div id="edit-tools">
-====Page Tools====
 [/rename.php?renamepage=Appendicitis%20%28Peds%29 Rename this page] [# Delete this page]<div class="editor-module"><div class="header">
+=== Insert links ===
-===Insert links===
 Insert links to other pages or uploaded files.
+</div><div class="editor-module-tabs">[# Pages] [# Images and files]</div><div class="content"><div id="thingbar-pages" style="display: none"><div style="border-bottom: 1px dotted rgb(187, 187, 187);  padding-bottom: 0.5em;  margin-bottom: 0.5em"><font size="10px">[javascript:void(0); Insert a link to a new page]</font></div>
-</div><div class="editor-module-tabs">[# Pages] [# Images and files]</div><div class="content"><div id="thingbar-pages" style="display: none"><div style="border-bottom: 1px dotted #bbb; padding-bottom: 0.5em; margin-bottom: 0.5em"><font size="10px">[javascript:void(0); Insert a link to a new page]</font></div>
+#<div><center>Loading...</center></div>
+</div><div id="thingbar-images" style="display: none"><div id="thingbar-upload" style="border-bottom: 1px dotted rgb(187, 187, 187);  padding-bottom: 0.5em;  margin-bottom: 0.5em"></div>
-# <div><center><span id="thingbarLoadIcon"></span> Loading...</center></div>
+#No images or files uploaded yet.
+<div style="border-top: 1px dotted rgb(187, 187, 187);  padding-top: 0.5em;  margin-top: 0.5em"><font size="10px">[javascript:void(0); Insert image from URL]</font></div></div></div></div></div>
-</div><div id="thingbar-images" style="display: none"><div id="thingbar-upload" style="border-bottom: 1px dotted #bbb; padding-bottom: 0.5em; margin-bottom: 0.5em"><font size="10px"></font></div>
-# No images or files uploaded yet.
-<div style="border-top: 1px dotted #bbb; padding-top: 0.5em; margin-top: 0.5em"><font size="10px">[javascript:void(0); Insert image from URL]</font></div></div></div></div></div>
 '''Tip:''' To turn text into a link, highlight the text, then click on a page or file from the list above.
 </div>
 |}
 </div></div>
-==Pearls==
-* Most common between 6-14 yrs (peak 9y-12y)
-* Perforation rate up to 92% in children <3 yrs old
-* Local tenderness + rigidity at McBurney's point is most reliable clinical sign
-* Analgesia does not delay diagnosis!
-* NPV of 98% achieved if:
-* Lack of nausea (or emesis or anorexia)
-* Lack of maximal TTP in the RLQ
-* Lack of neutrophil count > 6750
-== ==
-==Diagnosis==
-In children with abdominal pain:
+== Pearls ==
-Sx	+LR	-LR
+*Most common between 6-14 yrs (peak 9y-12y)
-Fever	3.4
+*Perforation rate up to 92% in children <3 yrs old
-Rebound	3.0	0.28
+*Local tenderness + rigidity at McBurney's point is most reliable clinical sign
-Migration	2.5	1.2
+*Analgesia does not delay diagnosis!
-WBC <10k	 	0.22
+*NPV of 98% achieved if:
-ANC <6,750	 	0.06
+*Lack of nausea (or emesis or anorexia)
-== ==
+*Lack of maximal TTP in the RLQ
+*Lack of neutrophil count > 6750
+==  ==
-==History & Physical==
+== Diagnosis ==
+In children with abdominal pain:
-* Neonates (birth - 30 days)
+Sx +LR -LR Fever 3.4 Rebound 3.0 0.28 Migration 2.5 1.2 WBC <10k 0.22 ANC <6,750 0.06
-* History
-* Vomiting
-* Irritability/lethargy
-* Physical
-* Abdominal distention
-* Infants (30 days - 2 yrs)
-* History
-* Vomiting
-* Abdominal pain
-* Fever
-* Physical
-* Diffuse abdominal tenderness
-* Localized RLQ TTP occurs <50%
-* Preschool (2 - 5yrs)
-* History
-* Vomiting (often precedes pain)
-* Abdominal pain
-* Fever
-* Physical
-* RLQ tenderness
-* School-age (6 - 12yrs)
-* History
-* Vomiting
-* Abdominal pain
-* Fever
-* Physical
-* RLQ tenderness
-* Adolescents ( >12yrs)
-* Present similar to adults
-* RLQ pain
-* Vomiting (occurs after onset of abdominal pain)
-* Anorexia
-== ==
+==  ==
-==Laboratory Findings==
+== History & Physical ==
+*Neonates (birth - 30 days)
+*History
+*Vomiting
+*Irritability/lethargy
+*Physical
+*Abdominal distention
+*Infants (30 days - 2 yrs)
+*History
+*Vomiting
+*Abdominal pain
+*Fever
+*Physical
+*Diffuse abdominal tenderness
+*Localized RLQ TTP occurs <50%
+*Preschool (2 - 5yrs)
+*History
+*Vomiting (often precedes pain)
+*Abdominal pain
+*Fever
+*Physical
+*RLQ tenderness
+*School-age (6 - 12yrs)
+*History
+*Vomiting
+*Abdominal pain
+*Fever
+*Physical
+*RLQ tenderness
+*Adolescents ( >12yrs)
+*Present similar to adults
+*RLQ pain
+*Vomiting (occurs after onset of abdominal pain)
+*Anorexia
-* WBC or neutrophil % elevation
+==  ==
-* Sn/Sp = 79/80%
-* May also be seen in gastroenteritis, strep, PNA, PID
-* CRP
-* May be more Sn than WBC in identifying perforation
-* Consider in pts with a prolonged history
-* UA
-* 7-25% of pts with appy have sterile pyuria
-==Imaging==
+== Laboratory Findings ==
+*WBC or neutrophil&nbsp;% elevation
+*Sn/Sp = 79/80%
+*May also be seen in gastroenteritis, strep, PNA, PID
+*CRP
+*May be more Sn than WBC in identifying perforation
+*Consider in pts with a prolonged history
+*UA
+*7-25% of pts with appy have sterile pyuria
-* Consider only in intermediate-risk pts
-* Ultrasound
-* Sn: 88%, Sp: 94%
-* Consider as 1st choice in non-obese children
-* CT (+/- contrast)
-* Sn: 94%, Sp: 95%
-* Consider if U/S is equivocal OR strong suspicion despite normal U/S
-Pediatric Appendicitis Score
-* Anorexia - 1pt
+== Imaging ==
-* Nausea or vomiting - 1pt
-* Migration of pain - 1pt
-* Fever > 100.5 - 1pt
-* Pain with cough, percussion, or hopping - 2pt
-* RLQ tenderness - 2pt
-* WBC > 10K - 1pt
-* Neutrophils + bands > 7500- 1pt
-* Score ≤ 2
-* Low risk (0-2.5%)
-* Consider d/c home with close f/u
-* Score ≥ 7
-* High risk
-* Consider surgical consultation
-* Score 3-6
-* Indeterminate risk
-* Consider serial exams, consultation, or imaging
-==Management==
+*Consider only in intermediate-risk pts
+*Ultrasound
+*Sn: 88%, Sp: 94%
+*Consider as 1st choice in non-obese children
+*CT (+/- contrast)
+*Sn: 94%, Sp: 95%
+*Consider if U/S is equivocal OR strong suspicion despite normal U/S
+<br/>Pediatric Appendicitis Score
-* Fluids (20 mL/kg boluses)
+*Anorexia - 1pt
-* Analgesia
+*Nausea or vomiting - 1pt
-* ABx
+*Migration of pain - 1pt
-* Second gen cephalosporin OR
+*Fever > 100.5 - 1pt
-* Piperacillin/tazobactam OR
+*Pain with cough, percussion, or hopping - 2pt
-* Penicillin allergy?
+*RLQ tenderness - 2pt
-* Gent + (clinda or metronidazole)
+*WBC > 10K - 1pt
+*Neutrophils + bands > 7500- 1pt
+*Score ≤ 2
+*Low risk (0-2.5%)
+*Consider d/c home with close f/u
+*Score ≥ 7
+*High risk
+*Consider surgical consultation
+*Score 3-6
+*Indeterminate risk
+*Consider serial exams, consultation, or imaging
-==Differential Diagnosis==
-* Emergent surgical diagnoses
+== Management ==
-* Bowel obstruction
-* Malrotation
-* Intussusception
-* Ovarian torsion
-* Ectopic pregnancy
-* Emergent nonsurgical diagnoses
-* HUS
-* DKA
-* Non-emergent diagnoses
-* PID
-* PNA
-* UTI
-* Strep throat
-* Gastroenteritis (esp yersinia)
-See Also
+*Fluids (20 mL/kg boluses)
+*Analgesia
+*ABx
+*Second gen cephalosporin OR
+*Piperacillin/tazobactam OR
+*Penicillin allergy?
+*Gent + (clinda or metronidazole)
-Peds:  Abdominal Pain (Peds)
-== ==
+== Differential Diagnosis ==
-==Source==
+*Emergent surgical diagnoses
+*Bowel obstruction
+*Malrotation
+*Intussusception
+*Ovarian torsion
+*Ectopic pregnancy
+*Emergent nonsurgical diagnoses
+*HUS
+*DKA
+*Non-emergent diagnoses
+*PID
+*PNA
+*UTI
+*Strep throat
+*Gastroenteritis (esp yersinia)
+<br/>See Also
-Bundy DG et al. Does this child have appendicitis? JAMA 2007; 298:438-451, UpToDate
+Peds: Abdominal Pain (Peds)
+==  ==
+== Source ==
+Bundy DG et al. Does this child have appendicitis? JAMA 2007; 298:438-451, UpToDate
-[[Category:Peds]]
+<br/>[[Category:Peds]]