MDCalc

Alvarado Score for Acute Appendicitis

Predicts likelihood of appendicitis diagnosis.

Signs

Right lower quadrant tenderness
Elevated temperature (37.3°C or 99.1°F)
Rebound tenderness

Symptoms

Migration of pain to the right lower quadrant
Anorexia
Nausea or vomiting

Laboratory Values

Leukocytosis >10,000
Leukocyte left shift
>75% neutrophils

Result:

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Advice

Always consider other causes of right lower quadrant pain in your differential diagnosis, including (but not limited to): urologic disease (like kidney stone), ovarian pathology (torsion, tubo-ovarian abscess), and other GI pathology (colitis, diverticulitis).

Management

  • Cutoffs differ by study, but one validated stratification assigns the highest risk to scores ≥9 in males or ≥10 in females and lowest risk to scores ≤1 in males or ≤2 in females (Coleman 2018).

  • In patients who are high risk, consider treatment without CT imaging, and in patients who are low risk, consider alternative diagnoses.