The Alvarado score is used to risk-stratify patients with suspected acute appendicitis. A 22-year-old man scores 7 (migration of pain to RIF, nausea/vomiting, RIF tenderness, leukocytosis, and elevated CRP). According to the Alvarado score management pathway, what is the recommended action?

• A Score 7 = low probability; discharge with analgesics and review in 24 hours
• B Score 7 = high probability; hospital admission and consider appendicectomy ✓
• C Score 7 = intermediate; mandatory CT scan before any surgical decision
• D Score 7 = confirmed appendicitis; proceed to immediate laparoscopic appendicectomy without further imaging

Explanation

The Alvarado (MANTRELS) score allocates points for migration of pain (1), anorexia (1), nausea/vomiting (1), RIF tenderness (2), rebound tenderness (1), elevated temperature (1), leukocytosis (2), left shift (1); maximum 10. Scores 7–10 = high probability of appendicitis; hospital admission, surgical assessment, and appendicectomy should be considered — though CT may be used selectively in equivocal cases or in women of reproductive age to exclude gynaecological pathology. Scores 5–6 = intermediate; CT or observation. Scores 1–4 = low probability; outpatient follow-up.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.