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Alvarado score

Clinical and laboratory score 0 to 10 estimating acute appendicitis probability in abdominal pain and assisting discharge, observation, imaging or surgery decisions.

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Check the population, units and version. The result shows the formula or classification; it does not make an automatic treatment decision.

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Method · Limits of application

Alvarado 1986: MANTRELS 8 items, 0–10; version with left shift

Alvarado 1986 was developed from 305 hospitalized patients with abdominal pain suggestive of appendicitis and eight clinical/laboratory factors. The original abstract does not automatically validate different age groups, pregnant patients or discharge/imaging strategies. Decision thresholds and the population of the version used must be checked separately; the tool implements the variant including a left shift.

Conditions of use

Check the population, units, inclusion and exclusion criteria, and version in the original source. A result alone does not establish a diagnosis, discharge decision or prescription.

Documented parameters

Pain migration to the right iliac fossa
Anorexia (or acetone in urine)
Nausea or vomiting
Right iliac fossa tenderness
Rebound tenderness (Blumberg sign)
Temperature ≥ 37.3 °C
Leukocytosis > 10,000/mm³
Left shift (neutrophils > 75%)

4/4 reference cases checked. Numerical tests are not clinical validation.

Sources and documentation

Documented formula

Transcribed from the source or a recorded revision; this is not a clinical recommendation.

MANTRELS: Migration (1), Anorexia (1), Nausea/vomiting (1), Tenderness in right iliac fossa (2), Rebound tenderness (1), Elevated temperature (1), Leukocytosis (2), Shift to the left (1). Total 0 to 10.

References

Identifier: escore-de-alvarado

Original clinical content: Brazilian Portuguese.

Method version

Alvarado 1986: MANTRELS 8 items, 0–10; version with left shift

escore-de-alvarado@native-2026-10-03+72bc80b1118a

Source for the active edition

The bibliographic edition identifies the source. By itself, it proves neither full conformity of the formula nor clinical approval.

Synthetic cases checked (4)

Synthetic cases for checking the implementation, with no patient data.

Case 1

reference-001

Inputs

Nausea or vomiting: Yes
Right iliac fossa tenderness: Yes
Pain migration to the right iliac fossa: No
Anorexia (or acetone in urine): No
Rebound tenderness (Blumberg sign): No
Temperature ≥ 37.3 °C: No
Leukocytosis > 10,000/mm³: No
Left shift (neutrophils > 75%): No

{
  "nausea": true,
  "dor": true,
  "migra": false,
  "anorex": false,
  "desc": false,
  "febre": false,
  "leuco": false,
  "desvio": false
}

Expected result

{
  "score": 3,
  "level": "low"
}

Actual result

{
  "score": 3
}

Case 2

reference-002

Inputs

Pain migration to the right iliac fossa: Yes
Anorexia (or acetone in urine): Yes
Right iliac fossa tenderness: Yes
Temperature ≥ 37.3 °C: Yes
Nausea or vomiting: No
Rebound tenderness (Blumberg sign): No
Leukocytosis > 10,000/mm³: No
Left shift (neutrophils > 75%): No

{
  "migra": true,
  "anorex": true,
  "dor": true,
  "febre": true,
  "nausea": false,
  "desc": false,
  "leuco": false,
  "desvio": false
}

Expected result

{
  "score": 5,
  "level": "mid"
}

Actual result

{
  "score": 5
}

Case 3

reference-003

Inputs

Pain migration to the right iliac fossa: Yes
Nausea or vomiting: Yes
Right iliac fossa tenderness: Yes
Rebound tenderness (Blumberg sign): Yes
Leukocytosis > 10,000/mm³: Yes
Anorexia (or acetone in urine): No
Temperature ≥ 37.3 °C: No
Left shift (neutrophils > 75%): No

{
  "migra": true,
  "nausea": true,
  "dor": true,
  "desc": true,
  "leuco": true,
  "anorex": false,
  "febre": false,
  "desvio": false
}

Expected result

{
  "score": 7,
  "level": "high",
  "verdict": "provável"
}

Actual result

{
  "score": 7
}

Case 4

reference-004

Inputs

Pain migration to the right iliac fossa: Yes
Anorexia (or acetone in urine): Yes
Nausea or vomiting: Yes
Right iliac fossa tenderness: Yes
Rebound tenderness (Blumberg sign): Yes
Temperature ≥ 37.3 °C: Yes
Leukocytosis > 10,000/mm³: Yes
Left shift (neutrophils > 75%): Yes

{
  "migra": true,
  "anorex": true,
  "nausea": true,
  "dor": true,
  "desc": true,
  "febre": true,
  "leuco": true,
  "desvio": true
}

Expected result

{
  "score": 10,
  "level": "high",
  "verdict": "muito provável"
}

Actual result

{
  "score": 10
}

Code and reproducibility

This tool’s code on GitHub

Download code and tests

Sources, version and reproduction instructions

The code tests are technical checks. Clinical approval and professional translation review are recorded separately.

Relationship with cancer research

General context — relationship to be defined

A resource for general clinical contexts. This edition does not assign a specific oncological relationship; selecting it for a study requires a justified question, population and purpose.