The Alvarado score is used in assessment of suspected appendicitis. A patient scores 7 points. What is the recommended management?

• A Discharge home with analgesia — score is insufficient for appendicitis
• B Immediate laparotomy without further imaging
• C Score 7 suggests probable appendicitis; surgical consultation and likely appendicectomy ✓
• D IV antibiotics alone as primary treatment

Explanation

The Alvarado (MANTRELS) score: migration to RIF, anorexia, nausea/vomiting (1 each), RIF tenderness (2), rebound tenderness (1), elevated temperature (1), leukocytosis (2), shift to left (1) — total 10 points. Score 1-4 = unlikely appendicitis (discharge/observe); 5-6 = possible appendicitis (observe/imaging); 7-8 = probable appendicitis (surgical consultation); 9-10 = very probable (operative). A score of 7 indicates probable appendicitis, warranting surgical consultation and appendicectomy (or CT confirmation in equivocal cases). The APPENDIX-CT and APPAC trials inform current management in adults.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

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Written and medically reviewed by the StethoPrep medical team.