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Am Fam Physician. 2023;107(3):301-302

This clinical content conforms to AAFP criteria for CME.

Author disclosure: No relevant financial relationships.

Clinical Question

In children and adolescents with lower abdominal pain, is there a way to identify low-, moderate-, and high-risk groups for suspected appendicitis?

Evidence Summary

The incidence of appendicitis in North America is approximately one episode per 1,000 people per year.1 The peak incidence in children and adolescents 10 to 19 years of age is 2.3 episodes per 1,000 people per year, with a lifetime prevalence of 8.6% for males and 6.7% for females.2 The evaluation of children and adolescents with clinically suspected appendicitis has potential harms, including unnecessary exposure to ionizing radiation from abdominal computed tomography scans at an age when tissue is more radiosensitive and unnecessary surgery in patients without appendicitis, which is more common in females.3

To help physicians distinguish children and adolescents with appendicitis from those with nonsurgical conditions, clinical prediction rules have been developed and prospectively validated. Ideally, these appendicitis risk scores would identify low-risk patients who could be sent home with close follow-up, moderate-risk patients who may require observation or imaging, and high-risk patients who would generally be managed surgically.

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This guide is one in a series that offers evidence-based tools to assist family physicians in improving their decision-making at the point of care.

This series is coordinated by Mark H. Ebell, MD, MS, deputy editor for evidence-based medicine.

A collection of Point-of-Care Guides published in AFP is available at

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