About the Alvarado Score
The Alvarado score is a clinical decision aid that estimates how likely acute appendicitis is in a person with abdominal pain. Introduced by Alfredo Alvarado in 1986, it turns eight bedside and laboratory findings into a single number from 0 to 10, usually remembered by the mnemonic MANTRELS. Clinicians use it as one input when deciding whether a patient needs observation, imaging, or surgical review.
How the score is built
Six of the eight criteria are worth 1 point and two are worth 2 points, for a maximum of 10:
- Migration of pain to the right lower quadrant — 1 point.
- Anorexia (loss of appetite) — 1 point.
- Nausea or vomiting — 1 point.
- Tenderness in the right lower quadrant — 2 points.
- Rebound pain on palpation — 1 point.
- Elevated temperature of 37.3°C (99.1°F) or higher — 1 point.
- Leukocytosis, a white blood cell count above 10,000/µL — 2 points.
- Shift to the left, neutrophils above 75 percent — 1 point.
This calculator takes Yes or No answers for the five symptoms and signs and reads the last three points directly from the temperature, white cell count, and neutrophil percentage you enter, so you do not have to apply the thresholds by hand.
Interpreting the total
A widely cited reading splits the score into three bands: 1 to 4 makes appendicitis unlikely, 5 to 6 is compatible or equivocal and often warrants observation, and 7 to 10 makes appendicitis probable. Some sources split the top band further (7 to 8 probable, 9 to 10 very probable). Right lower quadrant tenderness and a raised white cell count carry the most weight because each is worth 2 points.
When to consult a professional
The Alvarado score supports clinical judgement; it does not diagnose appendicitis and does not replace physical examination or imaging. A low score does not rule the condition out, and management always depends on the whole clinical picture. If you or someone you care for has severe or worsening abdominal pain, seek assessment from a licensed healthcare provider or emergency service.