Alvarado Score Calculator
Assess probability of acute appendicitis using clinical signs, symptoms, and laboratory data
Alvarado Score Assessment
Medical Disclaimer: This calculator is for educational purposes only and should not replace professional medical judgment. Always consult a healthcare provider for proper diagnosis and treatment of suspected appendicitis.
Signs (Physical Examination)
Pain in the right lower quadrant during palpation
Pain upon removal of pressure on the abdominal wall (Blumberg sign)
Fever above 99.1°F (37.3°C)
Symptoms
Epigastric pain migrating to the right lower quadrant
Loss of appetite
Feeling of sickness with inclination to vomit
Laboratory Tests
White blood count ≥10,000/µL
Increased number of immature neutrophils (band cells)
Alvarado Score Results
Clinical Recommendation
Appendicitis unlikely. Consider discharge with close follow-up.
Score Breakdown
Clinical Example
Case: 28-year-old Male
Presentation: Severe abdominal pain starting 8 hours ago
History: Pain initially in umbilical region, migrated to right lower quadrant
Symptoms: Fever, nausea, vomiting reported
Physical Exam: RLQ tenderness, rebound tenderness present
Lab Results: WBC 13,000/µL with left shift
Alvarado Score Calculation
• RLQ tenderness: +2 points
• Rebound tenderness: +1 point
• Elevated temperature: +1 point
• Migration of pain: +1 point
• Nausea: +1 point
• Leukocytosis: +2 points
• Left shift: +1 point
Total Score: 9/10 (Very High Risk)
Score Interpretation
Low Risk
<5% probability
Consider discharge with follow-up
Intermediate
13-59% probability
Observation and imaging studies
High Risk
75-85% probability
Consider surgical consultation
Very High
≥93% probability
Immediate surgical consultation
Additional Signs
Rovsing Sign
RLQ pain with LLQ palpation
Obturator Sign
RLQ pain with hip rotation
Psoas Sign
RLQ pain with hip extension
Dunphy Sign
Sharp RLQ pain with cough
Markle Sign
RLQ pain with heel drop
Emergency Resources
If severe abdominal pain, seek immediate medical care
Emergency: 911 (US) or local emergency number
Go to nearest emergency department for suspected appendicitis
Understanding the Alvarado Score
What is Appendicitis?
Appendicitis is inflammation of the vermiform appendix, a small finger-like structure attached to the cecum (part of the large intestine). It's one of the most common surgical emergencies, typically requiring immediate removal of the appendix (appendectomy).
Why Use the Alvarado Score?
- •Standardizes clinical assessment
- •Helps guide treatment decisions
- •Reduces unnecessary surgeries
- •Identifies patients needing imaging
Clinical Components
Signs (5 points maximum)
- • RLQ tenderness (2 points)
- • Rebound tenderness (1 point)
- • Elevated temperature (1 point)
Symptoms (3 points maximum)
- • Migration of pain (1 point)
- • Anorexia (1 point)
- • Nausea (1 point)
Laboratory (3 points maximum)
- • Leukocytosis >10,000/µL (2 points)
- • Left shift of neutrophils (1 point)
Important Clinical Notes
Limitations:
- • Less accurate in elderly patients
- • May be less reliable in pregnant women
- • Should not be the sole diagnostic tool
- • Consider imaging for intermediate scores
Modern Usage:
- • Primarily used to rule out appendicitis (scores 0-5)
- • High scores warrant surgical evaluation
- • Often combined with imaging studies
- • Part of comprehensive clinical assessment