This calculator is for general information and education. It is not medical advice and does not replace the judgment of a doctor, nurse or pharmacist who knows the full clinical picture.
Why a score for children?
Appendicitis is the most common reason for emergency abdominal surgery in children, but it is hard to recognize. Young children describe their pain poorly, and many other illnesses, from viral gastroenteritis to constipation, cause belly pain and vomiting. In 2002 the pediatric surgeon Madan Samuel published the Pediatric Appendicitis Score (PAS), a 10-point score built from a study of children aged 4 to 15.
The eight items
| Finding | Points |
|---|---|
| Pain in the right lower abdomen on coughing, percussion or hopping | 2 |
| Tenderness in the right lower abdomen | 2 |
| Loss of appetite | 1 |
| Fever of 100.4 °F (38 °C) or more | 1 |
| Nausea or vomiting | 1 |
| Pain that moved from around the navel to the right lower abdomen | 1 |
| White blood cells above 10,000/µL | 1 |
| Neutrophils above 7,500/µL | 1 |
Example
A 9-year-old has pain that worsens when hopping (2), no appetite (1), has vomited (1) and is tender in the right lower abdomen (2). There is no fever, the pain did not migrate and blood results are not yet available. The score is 6 out of 10: six clinical points and no laboratory points. That falls in the intermediate range, where doctors usually order an ultrasound, repeat the examination over a few hours or ask for a surgical opinion.
How the score is read
- 0 to 3: appendicitis is unlikely. Other causes are considered, with advice to return if the pain gets worse.
- 4 to 6: appendicitis is possible. Imaging, usually ultrasound first in children, and observation help decide.
- 7 to 10: appendicitis is likely, and a surgeon should assess the child urgently.
Later studies found that the score is good at ruling appendicitis out at low values and at flagging high-risk children, but that no single cutoff is perfect. It works best as part of a clinical pathway that includes ultrasound and repeat examination.
Compared with the Alvarado score
The Alvarado score, designed for adults, uses rebound tenderness, which is painful and unreliable in children. The PAS replaces it with pain on coughing, hopping or percussion, which children can show without being hurt. Both have similar overall accuracy.
When to seek care
Take a child to an emergency department for abdominal pain that keeps getting worse, pain with a fever, repeated vomiting, a hard or very tender belly, or pain that stops them from walking normally. Do not give laxatives to a child with unexplained abdominal pain.