Alvarado score calculator for appendicitis
Tick the symptoms, examination signs and blood results that are present to get the Alvarado score for suspected acute appendicitis. The score helps doctors decide on observation or imaging; it is information, not a diagnosis.
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How to use it
- Tick each symptom: pain that started around the navel and moved to the right lower abdomen, loss of appetite, nausea or vomiting.
- Tick the examination findings: tenderness and rebound pain in the right lower abdomen, temperature of 37.3 °C or more.
- Tick the blood results: white cell count above 10 × 10⁹/L (10,000/µL) and neutrophils above 75%.
- Read the score and its group.
How the score works
| Item |
Points |
| Migration of pain to the right lower quadrant |
1 |
| Anorexia |
1 |
| Nausea or vomiting |
1 |
| Tenderness in the right lower quadrant |
2 |
| Rebound pain |
1 |
| Temperature ≥ 37.3 °C |
1 |
| White cells > 10 × 10⁹/L |
2 |
| Neutrophils > 75% |
1 |
| Score |
Group |
| 0–4 |
Unlikely |
| 5–6 |
Possible |
| 7–8 |
Probable |
| 9–10 |
Very probable |
Worked example
A 22-year-old has pain that moved from the navel to the right side (1), no appetite (1), right lower tenderness (2) and a white count of 13 × 10⁹/L (2), with no fever, no rebound and neutrophils of 70%: 1 + 1 + 2 + 2 = 6, possible appendicitis. Rebound pain on re-examination would make it 7, probable.
Tips
- Re-score over time: appendicitis evolves, and a score that rises over a few hours means more than a single value.
- The white cell count and the neutrophil percentage come from the same blood count.
- Older adults and people on steroids may have few signs, so a low score is less reassuring.
- Severe or worsening abdominal pain needs a doctor’s examination; this page does not replace it.
Frequently asked questions
What does MANTRELS stand for?
Migration of pain, Anorexia, Nausea or vomiting, Tenderness in the right lower quadrant, Rebound pain, Elevated temperature, Leukocytosis and Shift to the left. Tenderness and leukocytosis are worth 2 points, the rest 1, for a maximum of 10.
What score suggests appendicitis?
In Alvarado's original grouping 5–6 is compatible with appendicitis, 7–8 makes it probable and 9–10 very probable. Scores of 4 or less make it unlikely, though not impossible.
Can the score replace an ultrasound or CT scan?
No. It is a way to sort patients: low scores support watching and re-examining, middle scores often lead to imaging, high scores to a surgical opinion. The surgeon's examination and imaging make the diagnosis.
Does it work for children and pregnant women?
It was developed in adults. Children have their own Pediatric Appendicitis Score, and in pregnancy the white cell count and the position of the appendix change, so the score is less reliable.