Clinical Scoring Systems in the Management of Suspected Appendicitis in Children

Abdominal pain is a common problem in children presenting to the Emergency Department (ED) and though the differential diagnosis is expansive, appendicitis is the most common surgical emergency of childhood. While many children present with classical findings of right lower quadrant (RLQ) pain associated with nausea or vomiting and fever, subtle features and difficult examinations can make identifying appendicitis in a child challenging, leaving Health Care Providers struggling to distinguish this surgical emergency from less urgent conditions. Appendicitis is a progressive condition making early recognition essential in limiting morbidity and mortality. While some suggest Diagnostic Imaging (DI) as a routine screen for all children with abdominal pain, ED wait times, fiscal restraints and increasing concern related to radiation exposure require a more prudent, selective approach to identifying the child with suspected appendicitis. Clinical Scoring Systems (CSSs) have been developed to assist clinicians in appropriately stratifying a child’s clinical risk of having appendicitis. This chapter reviews the literature and reports on the experience of a tertiary care Pediatric Emergency Department (PED) in incorporating a clinical score into a Clinical Pathway in order to stratify children into High/Moderate/Low risk for appendicitis, thus guiding management and departmental patient flow.