Alvarado Scoring System in Acute Appendicitis

Alvarado score is the most widely used clinical and laboratory-based scoring system to assist the diagnosis of acute appendicitis. Total Alvarado score is 10 and the score of 7 or more is strongly predictive of acute appendicitis. When the Alvarado score is 5 to 6, abdominal ultrasound or contrast enhanced CT examination helps to confirm the diagnosis of acute appendicitis. And, thus negative appendicectomy can be avoided. Clinical features of acute appendicitis contribute more to Alvarado scoring system than laboratory tests. Alvarado score is counted as given below which can be remembered with the help of the mnemonic MANTRELS.
Alvarado Score (MANTRELS)
• Migratory RIF pain: 1
• Anorexia: 1
• Nausea and vomiting: 1
• Tenderness in RIF: 2
• Rebound tenderness: 1
• Elevated temperature: 1
• Leucocytosis: 2
• Shift to left: 1
Total Alvarado score: 10
Getting abdominal ultrasound examination is more appropriate in children and thin people, particularly when gynaecological problems are suspected. While, on the other hand, in elderly patients, contrast-enhanced CT scan is more useful, particularly where the diagnosis is uncertain. Moreover, in elderly people where acute diverticulitis, intestinal obstruction and neoplasm are likely differential diagnoses, enhanced-contrast CT scan is helpful. But, it is cost-effective to run CT scan in the selective patients. Selective use of enhanced-contrast CT scan for the diagnosis of acute appendicitis reduces both the negative appendicectomy and length of hospital stay.

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Dr. Muzammil Irshad (


5 thoughts on “Alvarado Scoring System in Acute Appendicitis

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