Alvarado Score for Acute Appendicitis

EmergencySurgeryAbdominal painBeta toolThis tool is in beta. It has undergone internal validation but still requires additional testing. Always confirm the data entered and the results obtained before clinical use. It should not be used as the sole basis for clinical decisions.

Symptoms

Migration of pain to the right lower quadrant/right iliac fossaCapture an explicit Yes/No answer for the original MANTRELS symptom item.

YesNo

Anorexia / loss of appetiteCapture an explicit Yes/No answer rather than inferring it from incomplete history.

YesNo

Nausea or vomitingTreat this as the original combined nausea/vomiting symptom item.

YesNo

Signs

Right lower quadrant/right iliac fossa tendernessThis is the highest-weight examination item and contributes 2 points when present.

YesNo

Rebound tendernessUse a clinician-judged Yes/No determination for the original rebound-tenderness item.

YesNo

Elevated temperature / feverRecord fever as present or absent according to the clinical assessment; the original score treats it as a qualitative item.

YesNo

Laboratory findings

LeukocytosisEnter the already-established leukocytosis finding as Yes or No.

YesNo

Left shift / neutrophiliaEnter the already-established left-shift or neutrophilia finding as Yes or No.

YesNo

Enter the data

The result appears automatically once all required fields are complete.

Clinical noticeEducational appendicitis risk-stratification support only. Use the Alvarado score alongside clinical assessment, serial examination, and imaging pathways rather than as a stand-alone diagnostic rule.

Context and use

Alvarado = migration of pain (1) + anorexia (1) + nausea/vomiting (1) + RLQ tenderness (2) + rebound tenderness (1) + fever (1) + leukocytosis (2) + left shift (1)

Total score 0-10: 0-4 = low risk, 5-6 = intermediate risk, and 7-10 = high risk.