The following symptoms and complaints may indicate appendicitis (appendicitis):
- Pain, which usually occurs in the area of the right lower abdomen.
- Anorexia (loss of appetite)
- Nausea (nausea)/vomiting
- Urge to defecate
- Stool retention (in advanced stages a paralytic ileus/intestinal paralysis).
- Meteorism (flatulence)
- Slight to moderate temperature increase (38-39 °C; there is a temperature difference between rectal (“in the anus“) and axillary (“under the armpit”) measurement of about 1 °C).
Secondary symptoms
- Dysuria – pain during urination
- Polyuria – increased urination
- Tachycardia – heartbeat too fast: > 100 beats per minute.
- Dry tongue
Pediatric Appendicitis Score (PAS)
| Feature | Score |
| Anorexia (loss of appetite) | 1 |
| Nausea or vomiting | 1 |
| Pain migration to the right lower quadrant | 1 |
| Fever ≥ 38 °C | 1 |
| Maximum defensive voltage in the lower right quadrant | 2 |
| Pain in right lower quadrant on hopping, coughing, or percussion (palpating exam) | 2 |
| Leukocytosis ≥ 10,000/mm3 | 1 |
| Neutrophils ≥ 75% | 1 |
Evaluation of the risk of appendicitis:
- Score 0-3 = low risk
- Point value 4-6 = medium risk
- Point value 7-10 = high risk
Below, sonography results (negative, positive, equivocal appendicitis findings) are presented in relation to their prediction of appendicitis (in %) in combination with PAS scores.
| PAS values/risk | Negative sonography* | Positive sonography* * | Doubtful sonography |
| Low risk | 100 % | 73 % | 9 % |
| Medium risk | 94 % | 90 % | 13 % |
| High risk | 81 % | 97 % | 47 % |
* The negative predictive value indicates how likely it is that someone with a negative test result actually does not have the trait.* * The positive predictive value indicates how likely it is that someone with a positive test result actually does have the trait.
Conclusion:
- Children at high risk according to PAS score and negative sonography need to be carefully monitored
- Children at intermediate or high risk and positive sonography are candidates for appendectomy
- Children with intermediate risk according to PAS score and negative or equivocal sonography require observation
