🩹 Alvarado Score (Appendicitis)
Estimate the likelihood of acute appendicitis with the Alvarado (MANTRELS) score.
Alvarado Score (Appendicitis)
Migration of pain to RLQ
Anorexia
Nausea/vomiting
Tenderness in RLQ
Rebound tenderness
Elevated temperature ≥ 37.3°C
Leukocytosis > 10 ×10⁹/L
Left shift (neutrophilia > 75%)
When to use
Support decisions on imaging, observation or surgical referral in suspected appendicitis.
How it works
Migration 1, anorexia 1, nausea/vomiting 1, RLQ tenderness 2, rebound 1, fever 1, leukocytosis 2, left shift 1. ≤4 unlikely, 5–6 compatible, ≥7 probable.
Key points
- Less reliable in women and children.
- Intermediate scores usually warrant imaging.
- Not a substitute for surgical assessment.
References
Decision support for licensed clinicians only; not a substitute for clinical judgement, diagnosis or local protocols.