The Alvarado score (MANTRELS) is used to predict the probability of acute appendicitis. A score of 7-8 indicates:
- A Low probability of appendicitis; discharge with outpatient follow-up
- B High probability of appendicitis; immediate surgical intervention or operating theatre admission ✓
- C Moderate probability; CT scan recommended before any surgical decision
- D Equivocal; observe for 24 hours and repeat score
Correct answer: B. High probability of appendicitis; immediate surgical intervention or operating theatre admission
Explanation
The Alvarado score assigns points for symptoms and signs: migration of pain (1), anorexia (1), nausea/vomiting (1), RIF tenderness (2), rebound tenderness (1), elevated temperature (1), leucocytosis (2), shift to left (1) — total 10. A score of 7-10 is high probability and indicates urgent operative intervention. Score 5-6 is equivocal (observe or CT). Score ≤4 is low probability and observation or discharge is appropriate. CT is often used in equivocal cases to avoid negative appendicectomies while not delaying perforation cases.
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.