What goes into the Alvarado score
- Migration of pain to the right lower quadrant (+1)
- Anorexia (+1)
- Nausea or vomiting (+1)
- Right lower quadrant tenderness (+2)
- Rebound tenderness (+1)
- Temperature ≥ 37.3 °C (99.1 °F) (+1)
- WBC > 10,000/µL (+2)
- Left shift (neutrophils > 75%) (+1)
How to interpret the result
- ≤ 3: appendicitis unlikely
- 4–6: equivocal; image
- 7–10: appendicitis likely; surgical consultation
Clinical pearls
- Best for ruling out; high scores still over-call appendicitis, especially in women.
- CT is the usual test in adults; ultrasound first in pregnancy and young patients.
- CODA (2020): antibiotics are a reasonable alternative for selected uncomplicated cases, but about 3 in 10 need appendectomy by 90 days.
Evidence
- Alvarado A. A practical score for the early diagnosis of acute appendicitis. Ann Emerg Med. 1986;15:557-564.
Related workups
Related calculators
For education only. Check the inputs and the population the score was validated in before acting on it. Not a substitute for clinical judgment.