Alvarado score
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
The Alvarado score is a clinical scoring system used in the diagnosis of appendicitis. The score has 6 clinical items and 1 laboratory measurement which total 9 points. A score of less than 5 is not likely appendicitis, 5 or 6 is equivocal, 7 or 8 is probably appendicitis and 9 points means that the patient is highly likely to have appendicitis.
The Alvarado Score
Shown below is the Alvarado score in acute appendicitis which includes aelements from the patient's history, the physical examination and from laboratory tests.[1]
| Findings | Score |
| Abdominal pain that migrates to the right lower quadrant | 1 |
| Anorexia and/or ketones in the urine | 1 |
| Nausea and/or vomiting | 1 |
| Right lower quadrant tenderness | 2 |
| Rebound pain | 1 |
| Fever higher than 37.3°C by oral measurement | 1 |
| >10000 white blood cells per microliter | 2 |
| Shift to the left with >75% neutrophils | 1 |
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 A and T, one for all the others).
The Alvarado score has a very low sensitivity and a low specificity, especially in women who can have gynecological diseases mimicking appendicitis. The score has been modified to try and find adapted scores with higher clinical importance. Trials have studied the usefulness for the score in guiding the management of patients with pain in the right fossa, for example to see which patients need a CT scan and which patients need surgery.
See also
References
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
- ↑ Alvarado A (1986). "A practical score for the early diagnosis of acute appendicitis". Ann Emerg Med. 15 (5): 557–64. PMID 3963537.