ACEP Clinical Policy — Acute Appendicitis Evaluation and Management (2023)

The ACEP 2023 Clinical Policy on evaluation and management of adult ED patients with suspected acute appendicitis provides evidence-based guidance on: clinical risk stratification using validated scoring systems (Alvarado score, Adult Appendicitis Score, AIR Score), imaging strategy including ultrasound, CT, and MRI utilization, antibiotic treatment for uncomplicated appendicitis, and appendectomy vs. non-operative management (NOM). Acute appendicitis remains the most common acute surgical abdominal emergency (~300,000 appendectomies annually in North America), but evidence supports that a subset of uncomplicated appendicitis cases can be managed with antibiotics alone.