How is the Alvarado score calculated?

Eight findings are summed to a maximum of 10. Right-lower-quadrant tenderness and a white-cell count above 10,000/µL score 2 points each; migratory pain, anorexia, nausea or vomiting, rebound tenderness, fever ≥37.3°C, and a left shift above 75% neutrophils score 1 point each.

What do the Alvarado bands mean?

The classic reading is 1–4 appendicitis unlikely, 5–6 compatible, 7–8 probable, and 9–10 very probable. These are likelihood bands, not a diagnosis.

Can a high score confirm appendicitis?

No. The systematic review found the score reliable for ruling appendicitis out at a cut-point of 5, but a high score cannot rule in appendicitis without surgical assessment and further imaging or testing.

Is it safe to use in women, children, or pregnancy?

Use extra caution. The score over-predicts in women and is inconclusive in children, and pregnancy was excluded from the validating review. A low score does not safely rule out appendicitis in any unwell or atypical patient — get urgent in-person assessment.

Does any of the data I enter leave my browser?

No. The scoring runs entirely in your browser; nothing you enter is sent to a server or stored. The print option produces a clean worksheet you can save as a PDF.

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Alvarado score calculator

Tally the eight Alvarado (MANTRELS) findings for the published appendicitis likelihood band, with the systematic-review caveat that a high score cannot rule in appendicitis without surgical assessment. A scoring aid, not a diagnosis, and nothing you enter leaves your device.

Tick each Alvarado (MANTRELS) finding that is present. Right-lower- quadrant tenderness and leukocytosis score 2 points each; the other six score 1 point each.

MANTRELS findings present

Migration of pain to the right lower quadrantPain that began elsewhere and shifted to the RLQ+1AnorexiaLoss of appetite+1Nausea or vomitingReported nausea or vomiting+1Tenderness in the right lower quadrantRLQ tenderness on examination+2Rebound tendernessPain on release of palpation+1Elevated temperature (≥ 37.3 °C)Fever of 37.3 °C or higher+1Leukocytosis (WBC > 10,000/µL)White-cell count above 10,000 per microlitre+2Left shift (neutrophils > 75%)Neutrophils greater than 75% of white cells+1

Alvarado total

0/ 10

Appendicitis unlikely

The validating systematic review found the score dependable for ruling appendicitis OUT at a cut-point of 5, but a high score CANNOT rule appendicitis IN without surgical assessment and further imaging or testing. It over-predicts in women and is inconclusive in children.

A low score does NOT rule out appendicitis.

In women, children, pregnant, elderly, immunosuppressed, or any unwell patient, a low Alvarado score does not safely exclude appendicitis. Any patient with concerning abdominal pain needs urgent in-person assessment, whatever the score.

Scoring aid, not a diagnosis. The Alvarado score supports, but never replaces, clinical and surgical assessment. It reproduces a published score from findings you enter; it does not recommend imaging, surgery, observation, admission, discharge, or any drug, dose, or disposition. A low score does NOT safely rule out appendicitis in an unwell or atypical patient — women, children, pregnant, elderly, and immunosuppressed patients especially need urgent in-person evaluation, and the score over-predicts in women and is inconclusive in children (pregnancy was excluded from the validating review). The decision to image or operate rests with the treating clinician.

Privacy: Runs entirely in your browser — nothing you enter is sent to a server or stored.

Findings, point values, and bands reproduced from: Ohle R, O'Reilly F, O'Brien KK, Fahey T, Dimitrov BD. The Alvarado score for predicting acute appendicitis: a systematic review. BMC Medicine 2011;9:139 (PMC3299622)..

How the Alvarado (MANTRELS) score works

The Alvarado (MANTRELS) score adds eight findings from history, examination, and bloods — most worth 1 point, with right-lower- quadrant tenderness and leukocytosis worth 2 — into a 0–10 total that estimates the likelihood of acute appendicitis. The evidence is clear on how to read it: it is dependable for ruling appendicitis OUT at a low score, but a high score cannot rule it IN without surgical assessment and imaging. The number supports the clinician; it never replaces examination.

Many teams still tally MANTRELS on a scrap of paper. If you run a clinic on Avinya Plus, the same arithmetic can live on the note: our clinical templates in the EMR let you build the eight findings into a form and total them with the formula engine, so the band sits beside the examination instead of on a calculator. The arithmetic is the engine's; the judgement stays yours.

Frequently asked questions

How is the Alvarado score calculated?: Eight findings are summed to a maximum of 10. Right-lower-quadrant tenderness and a white-cell count above 10,000/µL score 2 points each; migratory pain, anorexia, nausea or vomiting, rebound tenderness, fever ≥37.3°C, and a left shift above 75% neutrophils score 1 point each.
What do the Alvarado bands mean?: The classic reading is 1–4 appendicitis unlikely, 5–6 compatible, 7–8 probable, and 9–10 very probable. These are likelihood bands, not a diagnosis.
Can a high score confirm appendicitis?: No. The systematic review found the score reliable for ruling appendicitis out at a cut-point of 5, but a high score cannot rule in appendicitis without surgical assessment and further imaging or testing.
Is it safe to use in women, children, or pregnancy?: Use extra caution. The score over-predicts in women and is inconclusive in children, and pregnancy was excluded from the validating review. A low score does not safely rule out appendicitis in any unwell or atypical patient — get urgent in-person assessment.
Does any of the data I enter leave my browser?: No. The scoring runs entirely in your browser; nothing you enter is sent to a server or stored. The print option produces a clean worksheet you can save as a PDF.

Sources

Ohle R, O'Reilly F, O'Brien KK, Fahey T, Dimitrov BD. The Alvarado score for predicting acute appendicitis: a systematic review. BMC Medicine 2011;9:139 (PMC3299622).

The eight findings, point values, and classic bands are reproduced from the Alvarado score as summarised in Ohle et al., BMC Medicine 2011 (PMC3299622). That systematic review found the score useful as a rule-out at a cut-point of 5 but unable to rule in appendicitis without surgical assessment and further testing, and it over-predicts in women. Reviewed against the source on 2026-06-29. Verify against the current guideline before relying on it.

Build the score into the consultation, not a calculator.

In Avinya Plus you can build the Alvarado findings into a clinical template, total them with the formula engine, and keep the band on the note — the arithmetic is the engine's, the judgement is yours. See it on a quick demo.