Accuracy of symptoms, signs, and basic laboratory tests for diagnosing appendicitis in children*
Symptom, sign, or testNumber of studies (n)Sensitivity (range)Specificity (range)+LR (summary value or range)−LR (summary value or range)
Fever1 (246)†75%78%3.40.32
4 (1738)26% to 93%29% to 75%1.20.53
Vomiting1 (246)†79%64%2.20.33
4 (1017)63% to 86%34% to 69%1.40.57
RLQ pain3 (2021)62% to 96%5% to 63%1.20.56
Pain migrating to RLQ2 (744)45% to 68%76% to 78%1.9 to 3.10.41 to 0.72
Localised tenderness1 (246)†21%81%1.11.0
RLQ tenderness4 (2200)80% to 97%5% to 52%1.30.45
Rebound tenderness3 (883)53% to 88%76% to 86%3.00.28
Rectal tenderness4 (1092)27% to 55%60% to 90%2.30.70
Involuntary guarding2 (744)62% to 86%63% to 67%1.6 to 2.60.21 to 0.61
White blood cell count (>10 000/μl)4 (1912)80% to 92%29% to 76%2.00.22
C-reactive protein (>8–10 mg/l)3 (522)64% to 85%33% to 82%1.3 to 3.60.44 to 0.47
Alvarado score (⩾7)3 (847)72% to 93%81% to 82%4.00.20
  • *Diagnostic terms defined in glossary; RLQ  =  right lower quadrant. †Level 1 study (unselected children with abdominal pain); all other studies are level 3 (selected patients with suspected appendicitis).

  • *Diagnostic terms defined in glossary; RLQ  =  right lower quadrant. †Level 1 study (unselected children with abdominal pain); all other studies are level 3 (selected patients with suspected appendicitis).