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).
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