Alvarado Score for Acute Appendicitis

Alvarado Score Calculator

Assess the likelihood of acute appendicitis in patients with abdominal pain

Symptoms (1 point each)

Migration of pain to right lower quadrant

Pain that begins around the umbilicus and migrates to the right lower quadrant

Anorexia (loss of appetite)

Patient reports decreased appetite or aversion to food

Nausea and/or vomiting

Patient reports feeling nauseated or has vomited

Signs

Right lower quadrant tenderness (2 points)

Pain on palpation of the right lower quadrant (McBurney's point)

Rebound pain/tenderness (1 point)

Pain when pressure is released after deep palpation (Blumberg's sign)

Elevated temperature ≥ 37.3°C (99.1°F) (1 point)

Fever indicating inflammatory process

Laboratory Findings

Leukocytosis (WBC > 10,000/μL) (2 points)

Elevated white blood cell count indicating infection/inflammation

Shift of WBC to the left (> 75% neutrophils) (1 point)

Increased percentage of neutrophils indicating acute bacterial infection

Notes:

The Alvarado Score should be used as an adjunct to clinical judgment
Consider imaging studies (ultrasound or CT) for intermediate scores (4-6)
In women of childbearing age, consider gynecological causes of pain
In elderly patients, appendicitis may present atypically with lower scores

About the Alvarado Score

The Alvarado Score is a clinical scoring system used to determine the likelihood of acute appendicitis in patients presenting with abdominal pain. It was developed to help clinicians make more accurate diagnoses and reduce the negative appendectomy rate.

Clinical Significance

The Alvarado Score helps clinicians stratify patients with suspected appendicitis into different risk categories, guiding decisions about further diagnostic testing, observation, or surgical intervention.

When to Use

Use this score for patients presenting with right lower quadrant abdominal pain and suspected appendicitis. The score is applicable to both s and children, though its accuracy may vary between these populations.

Interpretation

Score	Risk of Appendicitis	Recommended Action
0-3	Low (5-10%)	Discharge with precautions or observation
4-6	Intermediate (40-60%)	Observation, imaging studies (ultrasound or CT)
7-8	High (75-80%)	Surgical consultation, consider appendectomy
9-10	Very high (≥85%)	Appendectomy recommended

Limitations

The score may be less accurate in women of childbearing age due to gynecological conditions that can mimic appendicitis
Less reliable in elderly patients and children under 10 years
Does not account for atypical presentations of appendicitis
Should be used in conjunction with clinical judgment and appropriate imaging studies

Evidence Base

The Alvarado Score was originally described in 1986 and has been validated in multiple studies. It has a sensitivity of approximately 80% and specificity of 75% when using a cutoff score of 7 for the diagnosis of acute appendicitis.

References

Alvarado A. A practical score for the early diagnosis of acute appendicitis. Ann Emerg Med. 1986;15(5):557-564.
Ohle R, O'Reilly F, O'Brien KK, Fahey T, Dimitrov BD. The Alvarado score for predicting acute appendicitis: a systematic review. BMC Med. 2011;9:139.
Di Saverio S, Birindelli A, Kelly MD, et al. WSES Jerusalem guidelines for diagnosis and treatment of acute appendicitis. World J Emerg Surg. 2016;11:34.