The Alvarado score for acute appendicitis uses eight criteria. A patient scores 7 points. Which management is most appropriate based on the score?

• A Discharge with outpatient follow-up
• B Admission for observation and repeat examination only
• C CT abdomen is mandatory before any surgical decision
• D Appendicectomy is indicated ✓

Explanation

The Alvarado score (MANTRELS): each criterion scored 1 or 2 — migration of pain, anorexia, nausea/vomiting, RIF tenderness (2), rebound tenderness, elevated temperature, leukocytosis (2), and shift to left. Total 10 points. Score 7–10 indicates high probability of appendicitis and surgery (appendicectomy) is indicated without mandatory CT in uncomplicated presentations. Score 5–6 is equivocal (observation/CT); score <5 makes appendicitis unlikely. A score of 7 should prompt surgical intervention.

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

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