Alvarado Score Calculator

The Alvarado Score is a ten-point clinical decision aid for patients with suspected acute appendicitis. It combines three symptoms, three examination findings, and two laboratory findings. The mnemonic MANTRELS represents migration of pain, anorexia, nausea or vomiting, tenderness in the right lower quadrant, rebound pain, elevated temperature, leukocytosis, and shift of neutrophils to the left. Right lower quadrant tenderness and leukocytosis receive two points each; every other criterion receives one point. Traditional interpretations group totals from 0 to 4 as making appendicitis less likely, 5 to 6 as compatible with appendicitis, 7 to 8 as probable, and 9 to 10 as very probable. These labels summarize increasing likelihood, not certainty. Performance varies with age, sex, pregnancy, symptom duration, prevalence, examiner technique, and the population in which it is used. A low score may help identify some lower-risk patients, but it cannot safely dismiss severe or evolving symptoms without appropriate clinical review. Each item requires clinical judgment. Migration refers to pain that begins centrally and later localizes to the right lower quadrant. Tenderness and rebound are physical-examination findings. Fever thresholds and laboratory definitions for leukocytosis and neutrophil left shift may vary among protocols. The score should reflect findings at the time of assessment; early appendicitis may not yet produce fever, leukocytosis, or localized peritoneal signs. Modern care often combines clinical risk scores with repeat examination, ultrasound, computed tomography, magnetic resonance imaging, pregnancy testing, urinalysis, and other laboratory studies. Children, older adults, pregnant patients, and immunocompromised patients can have atypical presentations. Other urgent causes of abdominal pain can produce similar findings, including ectopic pregnancy, ovarian torsion, bowel obstruction, urinary disease, and inflammatory bowel disease. This calculator simply assigns the published point weights and adds them. It does not diagnose appendicitis, recommend surgery, or replace local pathways. Anyone with severe or worsening abdominal pain, guarding, fainting, persistent vomiting, a rigid abdomen, or signs of sepsis needs urgent medical evaluation. Clinicians should interpret the result alongside the full history, examination, laboratory data, imaging availability, and surgical consultation.