Alvarado score for suspected appendicitis

The Alvarado score combines three symptoms, three clinical signs and two laboratory values into a score from 0 to 10. It describes how likely acute appendicitis is.

⚠︎ Learning tool for medical education – not for use in patients or for treatment decisions.

Calculator

–points

🔒 Calculated only in your browser – nothing is stored or transmitted.

Classification (original publication)

ScoreClassification (original publication)
0–4Appendicitis unlikely – common later convention; Alvarado 1986 defines groups from 5 points
5–6Compatible with appendicitis – classification according to Alvarado 1986
7–8Appendicitis probable – classification according to Alvarado 1986
9–10Appendicitis very probable – classification according to Alvarado 1986

The mnemonic MANTRELS

The initial letters of the eight criteria spell MANTRELS. Right lower quadrant tenderness and leukocytosis score two points each; all other criteria score one point each.

Limitations

The derivation cohort included patients aged 4 to 80 years. In a systematic review (Ohle 2011) the score overestimated the probability in women and children but was well calibrated in men. It does not replace examination or imaging.

FAQ

What does MANTRELS stand for?▾

Migration, anorexia, nausea, tenderness, rebound, elevated temperature, leukocytosis, shift to the left.

References

  1. Alvarado A. A practical score for the early diagnosis of acute appendicitis. Ann Emerg Med 1986;15:557–64. · PubMed
  2. Ohle R et al. The Alvarado score for predicting acute appendicitis: a systematic review. BMC Med 2011;9:139. · PubMed

More Internal medicine calculators

Wells score for DVTWells score for pulmonary embolismCHA₂DS₂-VA scoreCHA₂DS₂-VASc scoreHAS-BLED scoreeGFR calculator (CKD-EPI 2021)qSOFA scoreCRB-65 score (pneumonia)

Keep learning

Keep learning with flashcards, exam questions and spot diagnoses in the KLINIKFUCHS app – free, in your browser or as an app.

Continue in your browserDownload on the App Store

Related pages: Wells score for DVT · Wells score for pulmonary embolism · CHA₂DS₂-VA score

All calculators in the app

InnereFuchs bundles Wells, CHA₂DS₂-VA, HAS-BLED, CRB-65, qSOFA, Child-Pugh, eGFR and more – together with flashcards and exam questions.

Open in browser  Download on the App Store

Intended purpose: learning tool for medical education only. Not intended for use in patients or for diagnostic or treatment decisions; not a medical device. Calculations follow the cited original publications; no guarantee of completeness or correctness. Last updated: 10/2026 · Dr. Pascal Bafteh