Alvarado Scoring

I. Criteria: Alvarado Score

1. Major criteria (assign 2 point for each positive)
Right lower quadrant tenderness to palpation
Leukocytosis (WBC Count >10,000)
2. Minor criteria (assign 1 point for each positive)
Abdominal Pain migrates to the right lower quadrant
Anorexia or (Urine Ketones positive)
Nausea or Vomiting
Rebound abdominal tenderness
Increased Temperature (37.3 C or 99.1 F)
Neutrophilia (cell count with Left Shift)

II. Criteria: MANTRELS mnemonic - same as Alvarado Score (all assigned 1 point except for the two
where noted)
Migration to the right lower quadrant
Anorexia
Nausea or Vomiting
Tenderness in the right lower quadrant (2 points)
Rebound pain
Elevated temperature
Leukocytosis (2 points)
Shift Left of Leukocytes

Interpretation
Score <4: Appendicitis unlikely
Score 5-6: Possible acute Appendicitis
Score 7-8: Probable Appendicitis
Score 9-10: Very probable acute Appendicitis

Protocol: Alvarado Score directed management
Score <4: No imaging required (Appendicitis unlikely)
Score 4-6: CT Abdomen
Score >6: Surgical consultation