Alvorado Score Calculator - Diseases and Health

Clinical Score

Alvarado Score Calculator

Estimate the likelihood of acute appendicitis using the MANTRELS clinical criteria based on symptoms, examination findings and laboratory results.

How to Use This Calculator

Select every clinical feature that is present.
The total Alvarado Score will update automatically.
Review the score category and selected-item breakdown.
Interpret the result together with clinical assessment, observation, imaging and local guidelines.

MANTRELS Criteria

Migration of pain to the right lower quadrant

Pain initially elsewhere that migrates to the right iliac fossa.

Anorexia

Reduced appetite associated with the current illness.

Nausea or vomiting

Either nausea, vomiting, or both are present.

Right lower quadrant tenderness

Localized tenderness on examination.

Rebound tenderness

Pain on release after abdominal palpation.

Elevated temperature ≥37.3°C

Measured body temperature at or above the scoring threshold.

Leukocytosis >10 × 10⁹/L

White blood cell count above 10,000/µL.

Neutrophil left shift >75%

Neutrophils comprise more than 75% of the differential count.

Alvarado Score

out of 10 points

Low score

A score of 0–4 generally indicates a lower likelihood of acute appendicitis. Clinical judgement remains essential.

Selected Criteria

No criteria selected0

Clinical notice: This calculator supports risk stratification only. It does not confirm or exclude appendicitis and must not delay urgent assessment in a patient with concerning abdominal symptoms.

Alvarado Score Interpretation

Score	General interpretation
0–4	Lower likelihood; appendicitis is less likely, but not excluded.
5–6	Equivocal or compatible with appendicitis; reassessment, observation or imaging may be considered according to the clinical setting.
7–8	Probable appendicitis; prompt surgical or specialist assessment is generally warranted.
9–10	Very high clinical suspicion for appendicitis; urgent management is required.

Frequently Asked Questions

What is the Alvarado Score used for?

The Alvarado Score is a clinical risk-stratification tool used to estimate the likelihood of acute appendicitis from symptoms, examination findings and laboratory results.

What does MANTRELS mean?

MANTRELS refers to Migration of pain, Anorexia, Nausea or vomiting, Tenderness in the right lower quadrant, Rebound tenderness, Elevated temperature, Leukocytosis and Shift to the left of neutrophils.

What is the maximum Alvarado Score?

The maximum score is 10 points. Right lower quadrant tenderness and leukocytosis contribute 2 points each, while the other criteria contribute 1 point each.

Does a high Alvarado Score confirm appendicitis?

No. A high score increases clinical suspicion but does not independently confirm appendicitis. Clinical assessment, observation, imaging and surgical review may still be required.

Can the Alvarado Score be used in children or pregnant patients?

It may be used as part of an assessment, but diagnostic performance can differ between populations. It should not replace population-specific clinical judgement, imaging or specialist evaluation.

References

Alvarado A. A practical score for the early diagnosis of acute appendicitis. Annals of Emergency Medicine. 1986;15(5):557–564.
Ohle R, O’Reilly F, O’Brien KK, Fahey T, Dimitrov BD. The Alvarado score for predicting acute appendicitis: a systematic review. BMC Medicine. 2011;9:139.
Di Saverio S, Podda M, De Simone B, et al. Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines. World Journal of Emergency Surgery. 2020;15:27.