Alvarado score

Last revised by Daniel J Bell on 27 Apr 2022

The Alvarado score is a clinical decision rule and predictor of the likelihood of acute appendicitis.

It is also known as the MANTRELS score from the initial letters of the criteria.

  • migration of pain to the right lower quadrant (+1)
  • anorexia (+1)
  • nausea or vomiting (+1)
  • tenderness in the right lower quadrant (+2)
  • rebound tenderness (+1)
  • elevated temperature (37.3°C or 99.1°F) (+1)
  • leukocytosis >10,000 (+2)
  • shift (of leukocytes) to the left (+1)
  • 5-6 compatible with acute appendicitis
  • 7-8 probable acute appendicitis
  • 9-10 very probable acute appendicitis

The score can be useful for decision-making when evaluating nonspecific imaging or equivocal ultrasound findings 2.

The score may be more useful for ruling out appendicitis with a score <5, than "ruling in" appendicitis with a >7 score 3.

Alfredo Alvarado (fl. 2022) is a retired American-Colombian general surgeon, living in Florida in the United States 4. In 2019 Dr Alvarado published an improved Alvarado score for the diagnosis of acute appendicitis 5.

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