The Alvarado score for acute appendicitis includes which set of clinical and laboratory parameters?

• A Migration of pain to RIF (1), anorexia (1), nausea/vomiting (1), RIF tenderness (2), rebound tenderness (1), elevated temperature (1), leukocytosis (2) — total 9 (MANTRELS mnemonic) ✓
• B Age, gender, CRP, WBC, temperature — five parameters scored 0–3
• C RIF tenderness, rebound, fever, WBC, CT evidence — scored 0–5
• D WBC, CRP, neutrophil %, abdominal guarding, duration of symptoms — Appendicitis Inflammatory Response score

Explanation

The Alvarado score (MANTRELS) assigns: Migration of pain to RIF (1), Anorexia (1), Nausea/vomiting (1), RIF Tenderness (2), Rebound tenderness (1), Elevated temperature (1), Leukocytosis >10,000 (2), and Left shift (1) — maximum 10. A score ≤4 makes appendicitis unlikely (discharge and observe); 5–6 is indeterminate (CT or observation); ≥7 is high probability for appendicitis. The Appendicitis Inflammatory Response (AIR) score incorporates WBC differential and CRP and has higher discrimination in some studies. The Pediatric Appendicitis Score uses different parameters. Option D describes the AIR score.

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

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