Paediatric Appendicitis Score (PAS)
8-item score to predict appendicitis in children aged 3–18 years. Score ≥ 6 has sensitivity > 90% for appendicitis.
Score interpretation
PAS 0–2: Low risk of appendicitis (~2%). Discharge with safety-netting.
→ Discharge with clear safety-net instructions. Return if: pain worsening, fever, vomiting, inability to mobilise. Review bloods at 12–24h if borderline. Re-examine if any doubt.
PAS 3–5: Intermediate risk (~20–30%). Serial examination and investigation required.
→ Admit for observation. IV access. Serial bloods (FBC, CRP) at 6–12h. IV fluids if poor oral intake. Nil by mouth if operative risk. USS abdomen — if non-diagnostic and high clinical concern: consider CT (radiation awareness) or MRI. Paediatric surgical review.
PAS ≥ 6: High risk of appendicitis (~75–90%). Surgical referral indicated.
→ Paediatric surgical review. IV antibiotics (co-amoxiclav or ceftriaxone + metronidazole). NBM. IV fluids. Confirm diagnosis: USS first-line; CT or MRI if USS non-diagnostic. Consent for laparoscopic appendicectomy. Theatre preparation.
Interpretation bands for the PAS. Apply clinical judgement and local guidance.
References
- Samuel M. Pediatric appendicitis score. J Pediatr Surg. 2002.
- NICE NG127. Appendicitis. 2019.
Related
Curated clinical cross-links plus same-class fallbacks.
- Ibuprofen (Orthopaedic Musculoskeletal Pain) · NSAID — Non-selective COX Inhibitor
- Paracetamol (Paediatric) · Analgesic / Antipyretic — First-Line Pain and Fever in Children
- Morphine (Paediatric) · Opioid Analgesic — Moderate to Severe Pain in Children
- Methoxyflurane · Inhaled Analgesic — Acute Pain
- Melatonin · Melatonin Receptor Agonist
- Fentanyl Transdermal Patch (Elderly Chronic Pain) · Opioid Analgesic — Transdermal Patch
- Major Trauma — Primary Survey (ATLS) · ATLS 10th Edition; JRCALC; NICE NG39
- Major Haemorrhage / Massive Transfusion · BCSH; RCOA; RCEM; RCS — BCSH Guidelines
- Burns — TBSA Estimation & Fluid Resuscitation · British Burn Association; EMSB; RCEM 2024
- Lower Gastrointestinal Bleed · NICE; BSG; ACPGBI — Commissioning Guide
- Acute Pancreatitis · NICE; IAP/APA; ACPGBI — CG104
- Hypertrophic Pyloric Stenosis · BAPS / RCPCH
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.