Alvarado Score

Acute appendicitis — likelihood

Migration of pain to the right lower quadrant

Anorexia

Nausea or vomiting

Tenderness in the right lower quadrant (2 points)

Rebound tenderness

Temperature ≥ 37.3 °C

Leukocytosis (WBC > 10 ×10⁹/L) (2 points)

Neutrophil left shift (> 75%)

Evidence

Original publication

Alvarado A. A practical score for the early diagnosis of acute appendicitis. The 8-item MANTRELS score; RLQ tenderness and leukocytosis are weighted 2 points.

Annals of Emergency Medicine, 1986

Open source

Validation

Ohle R, O’Reilly F, O’Brien KK, Fahey T, Dimitrov BD. The Alvarado score for predicting acute appendicitis: a systematic review. Pooled analysis across 42 studies; a cut-off of 5 rules out appendicitis reasonably well, higher cut-offs rule it in less reliably.

BMC Medicine, 2011

Open source

Last reviewed: 2026-09

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MedScore is an educational and clinical decision-support tool. It does not provide a diagnosis, a treatment, or a drug-dosing recommendation, and it does not replace clinical judgement or local guidelines. Confirm every result against the original source before acting on it. The treating clinician remains responsible for all decisions.