AskCalc
Home › Hepatology & GI › Alvarado

Alvarado Score for Acute Appendicitis

The Alvarado (MANTRELS) score estimates the probability of acute appendicitis from 8 findings (0–10 points). Scores 1–4 make appendicitis unlikely, 5–6 are equivocal, 7–8 probable and 9–10 very probable.

  • Migration of pain to the right lower quadrant (yes/no, +1)
  • Anorexia (or acetone in urine) (yes/no, +1)
  • Nausea or vomiting (yes/no, +1)
  • Right lower quadrant tenderness (yes/no, +2)
  • Rebound tenderness (yes/no, +1)
  • Temperature (°C or °F)
  • White blood cell count (×10⁹/L or ×10³/µL)
  • Neutrophils (% of WBC) (%)
—

Interpretation

ResultMeaning
1–4Unlikely
5–6Equivocal / compatible
7–8Probable
9–10Very probable

Formula

Migration of pain 1 · Anorexia 1 · Nausea/vomiting 1 · RLQ tenderness 2 · Rebound 1 · Temperature ≥37.3 °C 1 · Leukocytosis >10 ×10⁹/L 2 · Neutrophils >75% (left shift) 1

Clinical pearls

  • Best used to rule out (score <5); it over-predicts appendicitis in women of reproductive age.
  • In children the Pediatric Appendicitis Score is an alternative.

Examples

alvarado migration anorexia nausea rlq tenderness rebound temp 38.1 wbc 14 neut 82%Alvarado score: RLQ tenderness, no rebound, no migration, no anorexia, nausea, temp 37.0, WBC 9, neutrophils 70%appendicitis score 20F rlq pain rebound temp 37.4 wbc 11 neuts 78 no migration no anorexia no vomiting

FAQ

What Alvarado score means appendicitis?

7 or more makes appendicitis probable; 4 or less makes it unlikely.

What does MANTRELS stand for?

Migration, Anorexia, Nausea/vomiting, Tenderness in RLQ, Rebound, Elevated temperature, Leukocytosis, Shift to the left.

Evidence

  1. Alvarado A. A practical score for the early diagnosis of acute appendicitis. Ann Emerg Med 1986;15:557–64.

Hepatology & GI · Reviewed 2026-10-14 · Methodology