Appendicitis (peds): Difference between revisions
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**Vomiting (occurs after onset of abdominal pain) | **Vomiting (occurs after onset of abdominal pain) | ||
**Anorexia | **Anorexia | ||
==Differential Diagnosis== | |||
{{Pediatric abdominal pain DDX}} | |||
==Diagnosis== | ==Diagnosis== | ||
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**Sn: 94%, Sp: 95% | **Sn: 94%, Sp: 95% | ||
**Consider if U/S is equivocal OR strong suspicion despite normal U/S | **Consider if U/S is equivocal OR strong suspicion despite normal U/S | ||
== Management == | == Management == | ||
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**Perforation? | **Perforation? | ||
***[[Piperacillin/tazobactam]] | ***[[Piperacillin/tazobactam]] | ||
==Disposition== | |||
*Admission | |||
==See Also== | ==See Also== | ||
Revision as of 05:58, 30 July 2015
Background
- Most common between 9-12yr
- Perforation rate 90% in children <4yr
- NPV of 98% achieved if:
- Lack of nausea (or emesis or anorexia)
- Lack of maximal TTP in the RLQ
- Lack of neutrophil count > 6750
Clinical Features
- Local tenderness + McBurney's point rigidity most reliable clinical sign
Neonates
- 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%
- Diffuse abdominal tenderness
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
Differential Diagnosis
Pediatric Abdominal Pain
0–3 Months Old
- Emergent
- Nonemergent
3 mo–3 y old
- Emergent
- Nonemergent
3 y old–adolescence
- Emergent
- Nonemergent
Diagnosis
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
Laboratory Findings
- WBC
- <10K is strong negative predictor for appy
- 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
- Indeterminate US and an Alvarado <5 has an NPV of 99.6%[1]
- CT (+/- contrast)
- Sn: 94%, Sp: 95%
- Consider if U/S is equivocal OR strong suspicion despite normal U/S
Management
- NPO
- IVF (20 mL/kg boluses)
- Analgesia
- Antibiotics
- Ampicillin/sulbactam OR cefoxitin
- Penicillin allergy?
- Gentamycin + (clindamycin or metronidazole)
- Perforation?
Disposition
- Admission
See Also
References
- ↑ Blitman, et al. Value of focused appendicitis ultrasound and Alverado score in predicting appendicitis in children: Can we reduce the use of CT? AJR. 2015; 204:W707-W712.