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Pediatric Appendicitis Score (PAS)

Estimates acute appendicitis probability in children and adolescents with abdominal pain using symptoms, physical examination and complete blood count.

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Check the population, units and version. The result shows the formula or classification; it does not make an automatic treatment decision.

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Method · Limits of application

PAS/Samuel 2002: 8 factors, 0–10; not Alvarado or pARC

Samuel’s original PAS (2002) was derived in children aged 4–15 years. Goldman’s validation (2008) studied children aged 1–17 years with abdominal pain lasting less than 7 days; it excluded prior appendectomy and a diagnosis of appendicitis by ultrasound or CT already established on arrival. Assessing subjective symptoms requires care in children who cannot yet communicate them. The score is not pARC and does not determine diagnosis, discharge, imaging or surgery on its own.

Conditions of use

Check the population, units, inclusion and exclusion criteria, and version in the original source. A result alone does not establish a diagnosis, discharge decision or prescription.

Documented parameters

Right iliac fossa pain with coughing, percussion or hopping
Right iliac fossa tenderness
Anorexia
Fever (> 38 °C)
Nausea or vomiting
Pain migration to the right iliac fossa
Leukocytosis (> 10,000/mm³)
Neutrophilia (neutrophils > 7,500/mm³)

4/4 reference cases checked. Numerical tests are not clinical validation.

Sources and documentation

Documented formula

Transcribed from the source or a recorded revision; this is not a clinical recommendation.

2 points: right lower quadrant pain with coughing, percussion or hopping; right lower quadrant tenderness. 1 point: anorexia, fever, nausea/vomiting, pain migration, leukocytosis and neutrophilia. Total 0 to 10.

References

Identifier: pediatric-appendicitis-score

Original clinical content: Brazilian Portuguese.

Method version

PAS/Samuel 2002: 8 factors, 0–10; not Alvarado or pARC

pediatric-appendicitis-score@native-2026-10-03+280a54f88322

Samuel2002;DOI10.1053/jpsu.2002.32893

The bibliographic edition identifies the source. By itself, it proves neither full conformity of the formula nor clinical approval.

Synthetic cases checked (4)

Synthetic cases for checking the implementation, with no patient data.

Case 1

reference-001

Inputs

Anorexia: Yes
Nausea or vomiting: Yes
Right iliac fossa pain with coughing, percussion or hopping: No
Right iliac fossa tenderness: No
Fever (> 38 °C): No
Pain migration to the right iliac fossa: No
Leukocytosis (> 10,000/mm³): No
Neutrophilia (neutrophils > 7,500/mm³): No

{
  "anorexia": true,
  "nausea": true,
  "tosse": false,
  "fid": false,
  "febre": false,
  "migra": false,
  "leuco": false,
  "neut": false
}

Expected result

{
  "score": 2,
  "level": "low"
}

Actual result

{
  "score": 2
}

Case 2

reference-002

Inputs

Right iliac fossa pain with coughing, percussion or hopping: Yes
Right iliac fossa tenderness: Yes
Fever (> 38 °C): Yes
Anorexia: No
Nausea or vomiting: No
Pain migration to the right iliac fossa: No
Leukocytosis (> 10,000/mm³): No
Neutrophilia (neutrophils > 7,500/mm³): No

{
  "tosse": true,
  "fid": true,
  "febre": true,
  "anorexia": false,
  "nausea": false,
  "migra": false,
  "leuco": false,
  "neut": false
}

Expected result

{
  "score": 5,
  "level": "mid"
}

Actual result

{
  "score": 5
}

Case 3

reference-003

Inputs

Right iliac fossa pain with coughing, percussion or hopping: Yes
Right iliac fossa tenderness: Yes
Leukocytosis (> 10,000/mm³): Yes
Neutrophilia (neutrophils > 7,500/mm³): Yes
Pain migration to the right iliac fossa: Yes
Anorexia: No
Fever (> 38 °C): No
Nausea or vomiting: No

{
  "tosse": true,
  "fid": true,
  "leuco": true,
  "neut": true,
  "migra": true,
  "anorexia": false,
  "febre": false,
  "nausea": false
}

Expected result

{
  "score": 7,
  "level": "high"
}

Actual result

{
  "score": 7
}

Case 4

reference-004

Inputs

Right iliac fossa pain with coughing, percussion or hopping: Yes
Right iliac fossa tenderness: Yes
Anorexia: Yes
Fever (> 38 °C): Yes
Nausea or vomiting: Yes
Pain migration to the right iliac fossa: Yes
Leukocytosis (> 10,000/mm³): Yes
Neutrophilia (neutrophils > 7,500/mm³): Yes

{
  "tosse": true,
  "fid": true,
  "anorexia": true,
  "febre": true,
  "nausea": true,
  "migra": true,
  "leuco": true,
  "neut": true
}

Expected result

{
  "score": 10,
  "level": "high"
}

Actual result

{
  "score": 10
}

Code and reproducibility

This tool’s code on GitHub

Download code and tests

Sources, version and reproduction instructions

The code tests are technical checks. Clinical approval and professional translation review are recorded separately.

Relationship with cancer research

General context — relationship to be defined

A resource for general clinical contexts. This edition does not assign a specific oncological relationship; selecting it for a study requires a justified question, population and purpose.