Alvarado Score

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Clinical prediction rule for the diagnosis of appendicitis.

Clinical Presentation

Migration of pain to the RLQ

Anorexia (loss of appetite)

Nausea or Vomiting

Tenderness in the RLQWorth 2 Points

Rebound tenderness

Elevated temperature (≥ 37.3°C / 99.1°F)

Leukocytosis (WBC > 10,000/µL)Worth 2 Points

Shift to the left (Neutrophilia)

Appendicitis Probability

Total Points0/ 10

Risk LevelUnlikely30%

Recommendation:

Low clinical suspicion.

Persistent abdominal pain requires medical evaluation even if the score is low.

About this calculator

Overview

The Alvarado score, also known by the acronym MANTRELS, is a clinical scoring system used in the diagnosis of acute appendicitis. It helps identify patients who require immediate surgery and those who can be safely observed or discharged.

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Pro Tips

Migration of pain often starts around the belly button before moving to the right lower side.
Rebound tenderness is found when pain is worse when the pressure is released than when it is applied.
If a patient looks 'toxic' or has clear peritoneal signs, proceed to imaging regardless of a low score.

Fun Facts

"MANTRELS stands for: Migration, Anorexia, Nausea, Tenderness, Rebound, Elevated temp, Leukocytosis, Shift to left."
"A score of 7 or higher is strongly predictive of appendicitis."
"The score is slightly less accurate in children and elderly patients."
"RLQ tenderness and Leukocytosis are weighted more heavily (2 points each)."

Formula: Points (1-2) are assigned for Symptoms (Migration, Anorexia, Nausea), Signs (Tenderness, Rebound, Fever), and Labs (Leukocytosis, Shift).