🧒 Pediatric Appendicitis Score (PAS)
The Pediatric Appendicitis Score (PAS) stratifies appendicitis likelihood in children from eight clinical and laboratory items (0–10), guiding observation, imaging, or surgical referral.
Pediatric Appendicitis Score (PAS)
Pain migration to RLQ
Anorexia
Nausea or vomiting
Fever ≥ 38℃
RLQ tenderness (2 pts)
Cough/percussion/hopping elicits RLQ pain (2 pts)
WBC ≥ 10×10⁹/L
Neutrophils > 7.5×10⁹/L (or left shift)
When to use
Score migration, anorexia, nausea/vomiting, fever, RLQ tenderness (2), cough/percussion/hopping pain (2), leukocytosis, and neutrophilia; sum them. Use the band to triage to discharge, ultrasound, or surgical consult.
How it works
PAS = migration + anorexia + nausea + fever + 2×RLQ tenderness + 2×cough/percussion pain + WBC≥10 + neutrophils>7.5 (range 0–10). Bands: ≤3 low · 4–6 equivocal · ≥7 high.
Key points
- The two physical-exam items (RLQ tenderness, cough/percussion/hopping pain) are weighted double, reflecting their stronger discriminating value. (original synthesis · not guideline verbatim)
- PAS alone has only moderate sensitivity/specificity; an equivocal score (4–6) is an indication for ultrasound rather than direct operation or discharge.
- Serial re-examination over hours often resolves equivocal cases better than any single score; the tool supports, not replaces, surgical judgment.
References
- Samuel M. Pediatric appendicitis score. J Pediatr Surg. 2002;37(6):877-881.
- Di Saverio S, et al. WSES Jerusalem guidelines for diagnosis and treatment of acute appendicitis. World J Emerg Surg. 2020;15(1):27.
Decision support for licensed clinicians only; not a substitute for clinical judgement, diagnosis or local protocols.