Alvarado Score (MANTRELS)
Clinical scoring system for predicting acute appendicitis likelihood using symptoms, signs, and laboratory values.
Pain that migrated to the right lower quadrant
Loss of appetite or urine ketones positive
Presence of nausea or vomiting
Right lower quadrant tenderness to palpation (2 points)
Rebound abdominal tenderness
Temperature >= 37.3 C (99.1 F)
WBC > 10,000 cells/mm3 (2 points)
Cell count with left shift (1 point; removed in revised version)
References
- The Alvarado score for predicting acute appendicitis - a systematic review - BMC Medicine / NIH PMC
- Alvarado Score - StatPearls - NCBI Bookshelf
Clinical Notes & Warnings
- Not recommended as sole diagnostic tool due to limited sensitivity.
- Revised versions may exclude left shift criterion.
- Clinical judgment and imaging should accompany scoring.
MANTRELS mnemonic: Migration, Anorexia, Nausea, Tenderness (RLQ), Rebound, Elevated temp, Leukocytosis, Shift left.