Dhatt S, et al. - In view of the existence of improvement opportunities in the accuracy and timeliness of the diagnosis of childhood appendicitis, researchers here sought to carry out a postimplementation audit of a diagnostic pathway for children with suspected appendicitis presenting to their pediatric emergency department. A diagnostic pathway employing a validated risk of appendicitis stratification tool (Alvarado Score) with protocolized use of abdominal ultrasound was adopted for moderate-risk patients. They performed a 10% convenience sample audit of pathway patients managed over the subsequent 18-month period. Evaluation of 134 pathway patients was performed; of these, 22 (16.4%) had pathologically confirmed appendicitis. Pathway sensitivity was 81.8%, specificity-92.9%, and overall accuracy-91.0%. Hence with the implementation of a diagnostic pathway, a high level of accuracy was achieved and there was a reduction in the institutional negative appendectomy rate by 67%. The audit recognized added pathway improvement opportunities.