The Alvarado scoring system (MANTRELS) is used to predict acute appendicitis. A score of 7–10 indicates:

• A Low probability of appendicitis; discharge with outpatient follow-up
• B Equivocal — admit for observation and serial examination
• C High probability of appendicitis; surgical exploration strongly indicated ✓
• D Definitive diagnosis of perforated appendicitis requiring emergency laparotomy

Explanation

The Alvarado score (0–10) incorporates migration of pain to RIF, anorexia, nausea/vomiting, RIF tenderness, rebound tenderness, elevated temperature, leucocytosis, and left shift. Score 1–4: unlikely appendicitis, discharge or observe; score 5–6: equivocal, admit for observation and further investigation; score 7–10: high likelihood, proceed to surgical exploration (appendicectomy). It does not reliably distinguish simple from perforated appendicitis.

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

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Written and medically reviewed by the StethoPrep medical team.