Interpretation
| Result | Meaning |
|---|---|
| ≤ 3 | Low risk |
| 4–5 | Equivocal: imaging/observation |
| ≥ 6 | Consistent with appendicitis (Samuel cutoff) |
Formula
Cough/percussion/hopping RLQ tenderness 2 · RIF tenderness 2 · anorexia 1 · fever ≥38 °C 1 · nausea/vomiting 1 · WBC >10 ×10⁹/L 1 · neutrophilia 1 · migration of pain to RLQ 1 (max 10)
Clinical pearls
- Samuel reported sensitivity 100% and specificity 92% at ≥6, but external validations found much lower specificity; many pathways use ≤3 low risk and ≥7 high risk with imaging in between.
- Validated in children aged 4–15; younger children present atypically and perforate more often.
- Neutrophilia thresholds vary slightly between sources (ANC >7.5 ×10⁹/L is the most common).
Examples
pediatric appendicitis score 9 yo with rlq tenderness, pain with hopping, anorexia, wbc 14pas for child with nausea, fever, migration of pain to rlqpaediatric appendicitis score: no rlq tenderness, vomiting only
FAQ
What PAS score means appendicitis?
In Samuel's original study a score of 6 or more was consistent with appendicitis; 3 or less is low risk.
PAS or Alvarado in children?
Both perform similarly; PAS was designed for children and replaces rebound with cough/hop tenderness, which is easier to elicit in kids.