Pediatric Appendicitis Score (PAS)
Likelihood of appendicitis in children with acute abdominal pain
Sources last checked: 2026-11-03
Pediatric Appendicitis Score (PAS)
Likelihood of appendicitis in children with acute abdominal pain
Goldman 2008: a PAS ≤ 2 had high validity for ruling out appendicitis; 2.4 % of children with appendicitis scored ≤ 2.
Derived in children aged 4–15 years referred with suspected appendicitis (Samuel 2002); the bands come from an unselected emergency-department cohort aged 1–17 years (Goldman 2008). The original near-perfect accuracy was not reproduced in later cohorts. The score supports, but does not replace, clinical reassessment and imaging.
Interpretation
| Low (≤ 2) | Goldman 2008: a PAS ≤ 2 had high validity for ruling out appendicitis; 2.4 % of children with appendicitis scored ≤ 2. |
|---|---|
| Intermediate (3–6) | Goldman 2008: children with a PAS of 3–6 should undergo further investigation such as observation, ultrasound or CT. |
| High (≥ 7) | Goldman 2008: a PAS ≥ 7 had high validity for predicting appendicitis; 4 % of children taken to theatre on this basis alone would not have had appendicitis. |
What is the Pediatric Appendicitis Score (PAS)?
The Pediatric Appendicitis Score (PAS) estimates the likelihood of appendicitis in children with abdominal pain from six clinical findings and two blood-count results, for a total of 0–10 points. Samuel developed it prospectively in 1,170 children aged 4–15 years (J Pediatr Surg 2002). Goldman and colleagues validated it in 849 unselected emergency patients aged 1–17 years (J Pediatr 2008) and proposed the ≤ 2, 3–6 and ≥ 7 bands used here.
When to use it
- Children with acute abdominal pain (less than 7 days) in whom appendicitis is a possibility.
- Deciding between discharge with safety-netting, further investigation and surgical referral.
- Selecting children for ultrasound or observation in the intermediate range.
When not to use it
- Infants and toddlers who cannot localise pain or hop — several items cannot be assessed.
- Children with previous appendicectomy, chronic abdominal disease or immunosuppression.
- As a substitute for surgical review when peritonitis is clinically evident.
How it is calculated
| Criterion | Points |
|---|---|
| Cough, percussion or hopping tenderness in the right lower quadrant | +2 |
| Tenderness over the right iliac fossa (right lower quadrant) | +2 |
| Anorexia | +1 |
| Fever > 38 °C | +1 |
| Nausea or vomiting | +1 |
| Migration of pain to the right lower quadrant | +1 |
| Leukocytosis > 10 × 10⁹/L | +1 |
| Neutrophilia (absolute neutrophils > 7.5 × 10⁹/L) | +1 |
Clinical pearls and limitations
- Derived in children aged 4–15 years referred with suspected appendicitis (Samuel 2002); the bands come from an unselected emergency-department cohort aged 1–17 years (Goldman 2008). The original near-perfect accuracy was not reproduced in later cohorts. The score supports, but does not replace, clinical reassessment and imaging.
- The two examination items carry 2 points each: cough/percussion/hopping tenderness and right-iliac-fossa tenderness.
- In the 2008 validation 73 % of children without appendicitis scored ≤ 2, and 61 % of children with appendicitis scored ≥ 7.
- Over a third of children with appendicitis fell into the 3–6 range, where imaging or observation is needed.
- Repeat the score on reassessment — appendicitis evolves over hours.
Frequently asked questions
What does the Pediatric Appendicitis Score include?
Cough/percussion/hopping tenderness (2), right-iliac-fossa tenderness (2), anorexia, fever > 38 °C, nausea/vomiting, migration of pain, leukocytosis > 10 × 10⁹/L and neutrophilia (1 each).
What PAS score means appendicitis?
In the 2008 validation a score ≥ 7 had high validity for appendicitis and ≤ 2 for ruling it out; 3–6 needs further investigation.
PAS or Alvarado score in children?
Both use similar findings; the PAS was built specifically for children and replaces Alvarado's rebound tenderness with cough/percussion/hopping tenderness.
Evidence and guidelines
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<p><a href="https://medelix.ai/en/calculators/pediatric-appendicitis-score">Pediatric Appendicitis Score (PAS) calculator by Medelix</a></p>For healthcare professionals and medical students. These tools support, and do not replace, clinical judgement. Always check results against the original source and your local protocols.