Alvarado Score
Appendicitis unlikely
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Evidence-based calculations Used in clinical settings worldwide Regular monitoring recommended
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🏥 Sample Clinical Scenarios
🩺 Symptoms (M-A-N)
👋 Physical Signs (T-R-E)
🔬 Laboratory Findings (L-S)
👤 Patient Context (for interpretation)
Alvarado Score Result
Recommendation: Discharge with return precautions, consider alternative diagnoses
Score Breakdown by Category
Visual Analysis
📊 Alvarado Score Gauge
📈 Score by Category
🔍 Individual Component Analysis
Clinical Interpretation
Test Performance
Sensitivity: 96%
Specificity: 32%
Appendicitis Likelihood
Based on this score: <10%
Differential Considerations
Other considerations: gastroenteritis, urinary tract infection, kidney stones
Step-by-Step Calculation
The Alvarado Score uses the MANTRELS mnemonic to predict appendicitis likelihood.
Migration of pain to RLQ: No (0 points)
Anorexia: No (0 points)
Nausea/Vomiting: No (0 points)
Total Symptom Score: 0/3
RLQ Tenderness: No (0 points)
Rebound Tenderness: No (0 points)
Elevated Temperature (>37.3°C/99.1°F): No (0 points)
Total Sign Score: 0/4
Leukocytosis (WBC >10,000): No (0 points)
Left Shift (Neutrophils >70%): No (0 points)
Total Laboratory Score: 0/3
Total Alvarado Score = Symptoms + Signs + Laboratory
Total Alvarado Score = 0 + 0 + 0 = 0/10
Risk Category: Low Risk (Score 0-4)
Appendicitis Likelihood: <10%
Recommendation: Discharge with return precautions, consider alternative diagnoses
Alvarado Score Reference Table
| Score Range | Risk Level | Interpretation | Recommended Action |
|---|---|---|---|
| 0-4 | Low Risk | Appendicitis unlikely | Discharge with return precautions, consider alternative diagnoses |
| 5-6 | Intermediate Risk | Compatible with appendicitis | Further evaluation needed - consider CT imaging or observation |
| 7-8 | High Risk | Probable appendicitis | Surgical consultation recommended, CT if diagnosis uncertain |
| 9-10 | Very High Risk | Very probable appendicitis | Immediate surgical consultation for appendectomy |
For informational purposes only — not medical advice. Consult a healthcare professional before acting on results.
🏥 Health Facts
— WHO
— CDC
📋 What is the Alvarado Score?
The Alvarado Score, also known as the MANTRELS score, is a clinical scoring system developed in 1986 by Dr. Alfredo Alvarado to aid in the diagnosis of acute appendicitis. It remains one of the most widely used clinical prediction rules in emergency medicine for evaluating patients with suspected appendicitis.
The score combines eight clinical and laboratory findings into a single numeric value (0-10) that helps clinicians stratify patients by their likelihood of having appendicitis, guiding decisions about further workup, imaging, and surgical consultation.
MANTRELS Mnemonic
- M - Migration of pain to right iliac fossa (1 point)
- A - Anorexia (1 point)
- N - Nausea and/or Vomiting (1 point)
- T - Tenderness in right lower quadrant (2 points)
- R - Rebound pain (1 point)
- E - Elevated temperature (1 point)
- L - Leukocytosis (2 points)
- S - Shift to left of neutrophils (1 point)
🔧 How to Use the Alvarado Score
- Assess Symptoms: Ask about pain migration (periumbilical to RLQ), anorexia, and nausea/vomiting
- Perform Physical Exam: Check for RLQ tenderness, rebound tenderness, and measure temperature
- Obtain Laboratory Tests: Complete blood count with differential for WBC count and neutrophil percentage
- Calculate Total Score: Sum all present findings (maximum 10 points)
- Interpret Results: Use score thresholds to guide clinical decision-making
Clinical Decision Guide
- • Score 0-4: Appendicitis unlikely - discharge with return precautions
- • Score 5-6: Possible appendicitis - consider imaging (CT or ultrasound)
- • Score 7-8: Probable appendicitis - surgical consultation recommended
- • Score 9-10: Very probable appendicitis - immediate surgical consultation
⏰ When to Use the Alvarado Score
Appropriate Use
- • Emergency department evaluation of abdominal pain
- • Primary care assessment of suspected appendicitis
- • Triaging patients for imaging or surgical consultation
- • Resource-limited settings without CT availability
- • Decision support for observation vs discharge
Limitations
- • Less accurate in women of childbearing age
- • May miss atypical presentations in elderly
- • Not a replacement for clinical judgment
- • Should be used with imaging when available
- • Pediatric patients may have different presentations
📐 Alvarado Score Formula
Total Score = Symptoms + Signs + Laboratory
Total Score = (M + A + N) + (T + R + E) + (L + S)
Maximum Score = 3 + 4 + 3 = 10 points
| Component | Finding | Points |
|---|---|---|
| M | Migration of pain to RLQ | 1 |
| A | Anorexia | 1 |
| N | Nausea/Vomiting | 1 |
| T | RLQ Tenderness | 2 |
| R | Rebound Tenderness | 1 |
| E | Elevated Temperature (greater than 37.3°C) | 1 |
| L | Leukocytosis (greater than 10,000) | 2 |
| S | Shift to Left (greater than 70% neutrophils) | 1 |
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