Alvarado Score Calculator for Appendicitis Symptoms

How does this Alvarado score calculator work?

This is a health tool designed to evaluate the possibility of an individual suffering from acute appendicitis based on symptoms and clinical determinations.

The Alvarado score calculator consists of 3 categories and 8 factors that are taken in consideration in the final result, each in a different proportion. You can see the points awarded to each answer in the form above. The calculation consists in the addition of the points and then the resulting figure is interpreted.

Factors in the Alvarado score for acute appendicitis:

■ Signs:

- Tenderness in the right lower quadrant – physical examination revealing abdominal pain in right iliac fossa;

- Rebound tenderness – the Blumberg sign referring to pain upon the removal of pressure;

- Elevated temperature (37.3°C, 99.1°F) – fever present, temperature equal or higher to the values presented.

■ Symptoms:

- Pain migration to the right lower quadrant – physical examination revealing abdominal pain migrating towards the right iliac fossa;

- Anorexia – loss of appetite, often accompanied by ketones in urine;

- Nausea or vomiting.

■ Clinical determinations:

- Leukocytosis > 10,000 – inflammation sign of over 10k white blood cells per microliter in serum;

- Neutrophilia left shift – the leukocyte increase is usually in neutrophils and the left shift is observed in the ratio between the immature and mature neutrophils.

Alvarado mnemonic: MANTRELS or MAFLTRN (my appendix feels likely to rupture now).

Result interpretation

The numerical Alvarado score evaluates the possibility of an acute appendicitis. There are two interpretations that vary the cut off value that rules out appendicitis.

■ Scores < 4 with a sensitivity of 96%;

■ Score < 7 with a sensitivity of 58-88%.

The above Alvarado score calculator considers appendicitis unlikely at a score of 3 or below, possible at scores of 4 or 5, probable/ likely at scores of 6 - 8 and most likely at scores of 9 or above.

Appendicitis symptoms

This section is not only for medical professionals but also for people who are wondering which are the signs and symptoms of appendicitis and who try to rule out this condition.

An appendicitis crisis usually starts with an intermittent (may come and go) pain in the middle of the abdomen that travels towards the lower right side of the abdomen (where the appendix is located).

Pain might be increased by pressure, effort or simple walking. This can be accompanied by nausea, lack of appetite, diarrhea, general sensation of sickness. Fever and a flushed face are also symptoms to be considered.

Ruling out appendicitis

Symptoms presented above can also be met in other conditions of the gastro intestinal track or female reproductive tract. Therefore conditions such as gastroenteritis, irritable bowel syndrome, Crohn’s disease, urine infections or an ectopic pregnancy might present themselves with similar symptoms with pain varying in intensity.

References

1) Alvarado A. (1986) A practical score for the early diagnosis of acute appendicitis. Ann Emerg Med; 15(5): 557-64.

2) Tan WJ, Acharyya S, Goh YC, Chan WH, Wong WK, Ooi LL, Ong HS. (2015) Prospective comparison of the Alvarado score and CT scan in the evaluation of suspected appendicitis: a proposed algorithm to guide CT use; 220(2):218-24.