Appendicitis remains one of the most frequent surgical emergencies among children, yet it is highly difficult to diagnose. Traditional physical signs such as Rovsing’s, obturator, and psoas tests are routinely taught, but in practice they offer limited reliability. This diagnostic uncertainty can delay treatment or lead to unnecessary imaging and surgery.
This research determined whether the heel drop test (where a child stands on their toes and then drops their heels sharply to jar the abdomen) could offer a more objective and useful indicator of intraperitoneal inflammation, a hallmark of appendicitis. The team also aimed to build a new scoring system that blends this physical sign with standard clinical and laboratory markers.
From August 2021 to August 2023, 142 children presenting with suspected appendicitis were evaluated using a standardized protocol. Each child underwent routine blood tests, symptom assessment, and the heel drop test. Ultimately, 84 of these children were confirmed to have appendicitis.
The heel drop test proved to be a strong discriminator. It was significantly more likely to be positive in children with confirmed appendicitis and showed diagnostic performance similar to commonly used tenderness tests like cough, percussion, and hopping tenderness, while being simpler and less subjective to perform.
Using statistically significant predictors, this study developed a new scoring system called CHANSE, which stands for, C: CRP elevation, H: Heel drop test positivity, A: Anorexia, N: Nausea or vomiting, S: Shift to the left (immature white blood cells) and E: Elevated white blood cell count.
The study show that inflammatory markers (CRP and WBC), appetite loss, vomiting, and a positive heel drop test were all significantly more common in the appendicitis group. Also, the overall diagnostic performance of CHANSE with the widely used Pediatric Appendicitis Score (PAS), revealed that CHANSE had a higher area under the ROC curve which indicated better overall accuracy.
A CHANSE score of 3 or more provided predictive value similar to a high PAS score, while higher CHANSE values were linked to complicated appendicitis, such as perforation or abscess formation. Overall, the findings of this study support that the heel drop test is a practical, objective, and valuable addition to pediatric abdominal examinations.
Source:
Chun, M. K., Park, J. S., Kim, D., Han, J., Lee, J.-Y., Lee, J. S., & Choi, S. J. (2025). The CHANSE score: a novel clinical tool incorporating the heel drop test for the diagnosis of pediatric appendicitis. Frontiers in Pediatrics, 13(1724592). https://doi.org/10.3389/fped.2025.1724592
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