The Alvarado score for acute appendicitis assigns points for several clinical features. A patient has: migratory right iliac fossa pain (+1), anorexia (+1), nausea/vomiting (+1), RIF tenderness (+2), rebound tenderness (+1), elevated temperature 38.2°C (+1), leucocytosis 14 × 10⁹/L (+2), shift to left (+1) — total = 10. At this score, the recommended management is:

• A Observation with serial examinations; appendicectomy only if symptoms worsen
• B CT scan to confirm before surgery
• C Antibiotics alone (non-operative management) with appendicectomy deferred
• D Immediate appendicectomy without further imaging ✓

Explanation

The Alvarado score ranges 0–10: scores ≤4 suggest unlikely appendicitis (discharge/observation); 5–6 equivocal (consider imaging/admission); 7–8 probable (strongly consider surgery or CT); 9–10 definite appendicitis — proceed to appendicectomy. At a score of 10, the diagnosis is virtually certain and immediate appendicectomy is appropriate without further delay for imaging, as CT adds radiation without changing management. Non-operative management is an option only for uncomplicated appendicitis with good compliance and follow-up.

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

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Written and medically reviewed by the StethoPrep medical team.