There is no individual sign or symptom that can reliably exclude appendicitis in any patient. (Vissers RJ, 2010) The three most valuable historical clues include RLQ pain, migration of pain from the periumbilical region to the RLQ, and pain occurring prior to vomiting.  Symptoms helpful in excluding appendicitis include previous histories of similar pain and the absence of RLQ pain. (Cole MA, 2011)

There are three commonly used scoring systems to evaluate for appendicitis. These can be helpful to risk stratify patients who have signs and symptoms concerning for appendicitis. These three scores include the Alvarado Score (AS), the Pediatric Appendicitis Score (PAS), and the Appendicitis Inflammatory Response Score (AIRS). While the Appendicitis Inflammatory Response Score has demonstrated better performance than the Alvarado Score, all scoring systems are, alone, inadequate for determining the need for surgical intervention. They are however, good for risk stratifying the need for imaging studies.  (Andersson M, 2008)