Calculators · Paediatrics & Neonatology · Score

Paediatric Appendicitis Score (PAS, Samuel)

Also called Samuel score, PAS appendicitis, pediatric appendicitis score

Eight-item (0–10) score for the likelihood of acute appendicitis in children with abdominal pain.

PAS

0 / 10

Risk band
Low (≤2)

Low (≤2). Appendicitis unlikely: in Goldman's validation only 2.4% of children with appendicitis scored ≤2. Discharge with safety-netting is reasonable.

Formula and scoring

Cough/percussion/hopping tenderness 2 + RLQ tenderness 2 + anorexia 1 + fever 1 + nausea/vomiting 1 + migration of pain 1 + WBC >10,000 1 + ANC >7,500 1 = 10. Goldman 2008 bands: ≤2 low, 3–6 investigate, ≥7 high.

Exam and ward pearls

  • Samuel derived it in 1,170 children aged 4–15 years; Goldman validated it in unselected ED children aged 1–17.

When not to rely on it

  • Samuel's derivation cohort was aged 4–15 years and reported sensitivity 1.0 and specificity 0.92; expect lower accuracy in unselected emergency patients.
  • Use the bands to decide on observation or imaging, not to replace clinical judgement.

Source

  1. Samuel M. Pediatric appendicitis score. J Pediatr Surg. 2002;37(6):877-81. doi:10.1053/jpsu.2002.32893 · PMID 12037754
  2. Goldman RD, Carter S, Stephens D, Antoon R, Mounstephen W, Langer JC. Prospective validation of the pediatric appendicitis score. J Pediatr. 2008;153(2):278-82. doi:10.1016/j.jpeds.2008.01.033 · PMID 18534219

Formula and cut-offs checked against these sources on 8 Nov 2026. Educational tool for clinicians; it does not replace clinical judgement.

More Paediatrics & Neonatology calculators