Alvarado Score for Appendicitis Calculator

Alvarado (MANTRELS) score for the probability of acute appendicitis (0–10).

For educational and clinical reference. Not a substitute for medical judgment. See the medical disclaimer.

Migration of pain to right lower quadrant

Anorexia

Nausea or vomiting

Tenderness in right lower quadrant

Rebound tenderness

Elevated temperature ≥ 37.3 °C

Leukocytosis > 10,000/µL

Neutrophil left shift (> 75% neutrophils)

Score

—

Interpretation

—

References

Alvarado A. A practical score for the early diagnosis of acute appendicitis. Ann Emerg Med. 1986;15(5):557-564.

Select each symptom, sign, and laboratory finding that is present.
The total Alvarado score (0–10) and interpretation update instantly.
Use to guide observation, imaging, or surgical referral — not as a sole rule-out.

A 10-point clinical score (mnemonic MANTRELS) that estimates the probability of acute appendicitis from symptoms, signs, and labs.

A score ≥ 7 makes appendicitis probable; 5–6 is equivocal (observe or image); ≤ 4 makes it unlikely.

It performs less well in women of reproductive age (gynecologic mimics) and in young children; imaging is often added in these groups.

A score ≤ 4 has good but not perfect negative predictive value — persistent or worsening symptoms still warrant reassessment.

Last updated June 28, 2026