Should You Document the Hop/Skip/Jump Test in Appendicitis Evaluation?
Yes, you should document the hop/skip/jump test when evaluating patients for appendicitis, as it is a validated component of the Pediatric Appendicitis Score (PAS) and recent evidence demonstrates superior sensitivity compared to traditional peritoneal signs, particularly for identifying complicated appendicitis.
Evidence Supporting the Hop/Skip/Jump Test
In Pediatric Patients
The hop/skip/jump test (also called the Jumping-Up or J-Up test) demonstrated 80.3% sensitivity for appendicitis in children, significantly outperforming rebound tenderness (69.7% sensitivity) 1
In complicated appendicitis cases, the J-Up test achieved 92.9% sensitivity, making it the most sensitive physical examination finding for identifying severe disease 1
The test is formally incorporated into the Pediatric Appendicitis Score (PAS), which includes "right lower quadrant pain with coughing, hopping, or percussion" as a scored element 2
The PAS, which includes the hop test, has been validated in multiple studies and is recommended by major guidelines for risk stratification in children with suspected appendicitis 2
Practical Implementation
The test is performed by instructing patients to jump with both arms raised, then assessing pain response during landing 1
A positive result is defined by visible signs of pain including facial grimacing, abdominal guarding, or verbal complaints of pain 1
The test is particularly valuable in children aged 6-17 years who can cooperate with the maneuver 1
Integration with Clinical Scoring Systems
Recommended Approach
Use validated clinical scoring systems (AIR score, AAS score in adults; PAS or AIR score in children) that incorporate peritoneal signs including the hop/skip test 2, 3
The hop test should be documented alongside other peritoneal signs such as rebound tenderness, guarding, psoas sign, and obturator sign 4, 1
Clinical scores alone are sufficiently sensitive to exclude appendicitis and identify low-risk patients who may not need imaging 2
Why Documentation Matters
Validated scoring systems that include the hop test decrease negative appendectomy rates and reduce unnecessary imaging in low-risk patients 2
Documentation supports risk stratification decisions about whether to proceed with observation, imaging, or surgical consultation 2, 3
The presence of positive peritoneal signs (including hop test) increases the likelihood of appendicitis and helps justify imaging or surgical intervention 4, 5
Common Pitfalls to Avoid
Do not rely on the hop test alone—it must be integrated into a comprehensive clinical scoring system with laboratory values and other clinical findings 2, 3
In preschool-aged children (under 6 years), the hop test may not be feasible due to limited cooperation, requiring greater reliance on imaging 2, 6
The absence of a positive hop test does not exclude appendicitis, as sensitivity is only 80.3% in the best studies 1
Always combine physical examination findings with laboratory markers (WBC with differential, CRP) and validated clinical scores rather than interpreting individual signs in isolation 3, 7, 5
Clinical Algorithm for Documentation
For all patients with suspected appendicitis:
Document the hop/skip/jump test result (positive/negative/unable to perform) 1
Calculate and document a validated clinical score (PAS in children, AIR or AAS in adults) that incorporates this finding 2, 3
Low-risk patients (low clinical scores with negative hop test): Consider discharge without imaging 2
Intermediate-risk patients: Proceed to ultrasound as first-line imaging regardless of hop test result 3, 6
High-risk patients (high clinical scores with positive hop test): Proceed to CT or surgical consultation 3, 7