Alvarado score for Appendicitis

        The Alvarado score is a clinical scoring system used in the diagnosis of appendicitis. The score has 6 clinical items and 2 laboratory measurements with a total 10 points.

The score
1. Abdominal pain that migrates to the right iliac fossa
2. Anorexia (loss of appetite) or ketones in the urine
3. Nausea or vomiting
4. Pain on pressure in the right iliac fossa
5. Rebound tenderness
6. Fever of 38.3 °C or more
7. Leukocytosis, or more than 10000 white blood cells per microliter in the serum
8. Neutrophilia, or an increase in the percentage of neutrophils in the serum white blood cell count.

The two most important factors, tenderness in the right lower quadrant and leukocytosis, are assigned two points, and the six other factors are assigned one point each, for a possible total score of ten points.

A score of 5 or 6 is compatible with the diagnosis of acute appendicitis. A score of 7 or 8 indicates a probable appendicitis, and a score of 9 or 10 indicates a very probable acute appendicitis.

A mnemonic used to remember the Alvarado score factors is :
MANTRELS
Migration to the right iliac fossa
Anorexia
Nausea/Vomiting
Tenderness in the right iliac fossa
Rebound pain
Elevated temperature (fever)
Leukocytosis, and
Shift of leukocytes to the left.