The Alvarado score is widely used for risk stratification in suspected appendicitis. A score of 7–10 indicates which probability of acute appendicitis and management?
- A Low probability (<20%); discharge with analgesia and outpatient review
- B Moderate probability (40–60%); CT abdomen to confirm before operating
- C High probability (>80%); direct to surgery (appendicectomy) in males; CT or diagnostic laparoscopy in equivocal females ✓
- D High probability; mandatory CT scan for all patients before surgery regardless of sex
Explanation
The Alvarado score (MANTRELS) uses 8 criteria (migration of pain to RIF, anorexia, nausea/vomiting, RIF tenderness, rebound tenderness, elevated temperature, leucocytosis, shift to left). Score 1–4: low probability, observe/discharge; 5–6: intermediate, imaging or observe; 7–10: high probability (positive predictive value >80–90%). Current ACES and RCS guidelines recommend direct appendicectomy for males with scores 7–10, while in females (where ovarian pathology must be excluded) CT or diagnostic laparoscopy is preferred. Universal CT increases radiation burden without improving outcomes in high-score males.
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.