Alvarado score

The Alvarado score is a clinical scoring system used in the diagnosis of appendicitis. The score has 6 clinical items and 2 laboratory measurements with a total 10 points.

The score

Elements from the patient's history, the physical examination and from laboratory tests:

• Abdominal pain that migrates to the right iliac fossa
• Anorexia (loss of appetite) or ketones in the urine
• Nausea or vomiting
• Pain on pressure in the right iliac fossa
• Rebound tenderness
• Fever of 37.3 °C or more
• Leukocytosis, or more than 10000 white blood cells per microliter in the serum
• Neutrophilia, or an increase in the percentage of neutrophils in the serum white blood cell count.

The two most important factors, tenderness in the right lower quadrant and leukocytosis, are assigned two points, and the six other factors are assigned one point each, for a possible total score of ten points.

A score of 5 or 6 is compatible with the diagnosis of acute appendicitis. A score of 7 or 8 indicates a probable appendicitis, and a score of 9 or 10 indicates a very probable acute appendicitis.

A popular mnemonic used to remember the Alvarado score factors is MANTRELS - Migration to the right iliac fossa, Anorexia, Nausea/Vomiting, Tenderness in the right iliac fossa, Rebound pain, Elevated temperature (fever), Leukocytosis, and Shift of leukocytes to the left (factors listed in the same order as presented above). Due to the popularity of this mnemonic, the Alvarado score is sometimes referred to as the MANTRELS score.

A useful mnemonic to remember the modified Alvarado score is: MAFLTRN - My Appendix Feels Likely To Rupture Now (2 points for L and T, one for all the others).

Complementary value

The original Alvarado score describes a possible total of 10 points, but those medical facilities that are unable to perform a differential white blood cell count, are using a Modified Alvarado Score with a total of 9 points which could be not as accurate as the original score. The high diagnostic value of the score has been confirmed in a number of studies across the world. The consensus is that the Alvarado score is a noninvasive, safe, diagnostic method, which is simple, reliable and repeatable, and able to guide the clinician in the management of the case.

See also

• Appendicitis

References

• Alvarado A. A practical score for the early diagnosis of acute appendicitis. Ann Emerg Med 1986; 15: 557-564
• C D Douglas, N E Macpherson, P M Davidson, J S Gani. Randomised controlled trial of ultrasonography in diagnosis of acute appendicitis, incorporating the Alvarado score. BMJ October 14, 2000; 321(7266):919
• McKay R, Shepherd J. The use of the clinical scoring system by Alvarado in the decision to perform computed tomography for acute appendicitis in the ED. Am J Emerg Med 2007; 25(5): 489-93. PMID 17543650
• Crnogorac S, Lovrenski J. Validation of the Alvarado score in the diagnosis of acute appendicitis. Med Pregl 2001 Nov-Dec; 54(11-12):557-61
• Chan M Y P, Teo B S, Ng B L. The Alvarado score and acute appendicitis. Ann Acad Med Singapore 2001; 30:510-2
• Khan I, Rehman A. Application of Alvarado scoring system in diagnosis of acute appendicitis. J Ayub Med Coll Abbottabad 2005; 17(3)
• Mackin C P, Radcliffe, G S, Merei J M, Stringer M D. A prospective evaluation of the modified Alvarado score for acute appendicitis in children. Ann Coll Surg Engl. 1997 May; 79(3); 203-205
• Al Qahtani HH, Muhammad AA. Alvarado score as an admission criterion for suspected appendicitis in adults. Saudi J Gastroenterol 2004; 10:86-91