Clinical Practice Guidelines: Appendicitis



Appendicitis is a common pediatric surgical emergency. Despite its frequency, there is significant practice variability for diagnosing appendicitis in both general and pediatric-specific hospitals. Multiple clinical prediction tools have been validated to help standardize the diagnostic evaluation of appendicitis in children. While many children are diagnosed by ultrasound or by history and physical examination, the use of computed tomography has persisted. Given the increased lifetime risk of cancer due to the exposure of radiation from this imaging modality, standardizing the evaluation of appendicitis is needed. 
The Pediatric Surgery Quality Collaborative in partnership with the American College of Surgeons National Surgery Quality Improvement Program Pediatric Hospitals initiated a nationwide effort starting in 2020 to reduce the use of CT imaging in children in the diagnosis of appendicitis. Monroe Carell Jr. Children’s Hospital at Vanderbilt, in an effort to provide the best care for children with appendicitis, has agreed to participate in this collaborative. 
The goal of this clinical practice guideline is to encourage the use of the Pediatric Appendicitis Score, a clinical prediction tool, to help stratify the risk of appendicitis and to standardize the use of diagnostic tools and involvement of pediatric surgery with the ultimate goal of reducing CT imaging. Additional measures that will be monitored is emergency department time to diagnosis, the rate of negative pathology appendicitis, and emergency department return visits within 72 hours. 



  • Monica Lopez, MD – Pediatric Surgery
  • Martin Blakely, MD – Pediatric Surgery
  • Barron Frazier, MD – Pediatric Emergency Medicine
  • Marta Hernanz-Schulman – Pediatric Radiology 
  • Melissa Danko, MD – Pediatric Surgery 
  • Jacob Olson, MD, Pediatric Surgery
  • Caroline Godfrey, MD, General Surgery
  • Anuradha Patel, MD, Pediatric Surgery
  • Jenny Overfield, MD – Pediatrics
  • Jessica Hayes, MD – Pediatrics
  • Clark Thornton, MD – Pediatrics 


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