Alvarado Score Calculator (Acute Appendicitis)
The Alvarado score (mnemonic MANTRELS) estimates the likelihood of acute appendicitis from eight clinical and laboratory findings — migratory right-lower-quadrant pain, anorexia, nausea/vomiting, RLQ tenderness, rebound tenderness, fever, leukocytosis and a left shift — for a total of 0 to 10.
Quick answer
The Alvarado score (MANTRELS) adds points for migratory right-lower-quadrant pain, anorexia, nausea/vomiting, RLQ tenderness (2), rebound tenderness, fever ≥37.3 °C, leukocytosis over 10,000/µL (2) and a left shift, for a total of 0–10. A score of 1–4 makes appendicitis unlikely, 5–6 is compatible, 7–8 probable, and 9–10 very probable.
Symptoms
Signs
Laboratory
Appendicitis unlikely (1–4)
The Alvarado score is 0/10: appendicitis unlikely (1–4). The mnemonic is MANTRELS, with right-lower-quadrant tenderness and leukocytosis each weighted 2 points.
This is a reference estimate that supports — but does not replace — clinical assessment and imaging. A clinician interprets it in context.
How to use the Alvarado calculator
- 1Tick the symptoms and signs. Tick migratory pain to the right lower quadrant, anorexia, nausea or vomiting, right-lower-quadrant tenderness, and rebound tenderness as they apply.
- 2Add temperature and blood findings. Tick fever (37.3 °C or higher), leukocytosis (white-cell count over 10,000/µL), and a left shift (neutrophils over 75%).
- 3Read the score and band. The tool totals the points (0–10) and shows the band — unlikely (1–4), compatible/observe (5–6), probable (7–8) or very probable (9–10) — to interpret with a clinician.
Medical disclaimer: This is general health information, not medical advice. It does not diagnose or treat any condition, and the results are estimates based on public reference formulas. Always consult a qualified doctor about your individual health. If you think you may have a medical emergency, contact your local emergency services immediately.
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Book a consultationFrequently asked questions
What Alvarado score suggests appendicitis?⌄
A score of 7 or more makes acute appendicitis probable, and 9–10 very probable; 1–4 makes it unlikely, while 5–6 is compatible and usually prompts observation or imaging. The score supports, but does not replace, clinical assessment and imaging.
What does MANTRELS stand for?⌄
MANTRELS is the mnemonic for the eight components: Migration of pain, Anorexia, Nausea/vomiting, Tenderness in the right lower quadrant, Rebound tenderness, Elevated temperature, Leukocytosis, and Shift of white cells to the left.
Why do tenderness and leukocytosis score 2 points?⌄
In the original Alvarado derivation, right-lower-quadrant tenderness and leukocytosis were the two most predictive findings, so each is weighted 2 points while the other six items score 1 point each.
Is my data stored?⌄
No. The calculator runs entirely in your browser; nothing you enter is sent to a server.
Sources & validation
This calculator reproduces the published Alvarado score, validated for likelihood of acute appendicitis in patients with abdominal pain.
- Alvarado A. A practical score for the early diagnosis of acute appendicitis (Ann Emerg Med 1986;15:557-564) — the original 10-point MANTRELS score — verified 2026-06-18
- Alvarado score overview, StatPearls (NCBI Bookshelf) — item points and the unlikely / compatible / probable interpretation bands — verified 2026-06-18
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