Gastroenterology Surgery A

Modified Alvarado Score (MANTRELS) for Appendicitis

Modified clinical scoring system for acute appendicitis diagnosis in adults. Score 0–10.

Score interpretation

Low Risk — Appendicitis Unlikely 0–4

Score ≤4. Appendicitis unlikely. Negative predictive value ~90%.

→ Discharge with advice and return precautions. No operative intervention required. Outpatient follow-up if symptoms persist.

Intermediate — Observation Required 5–6

Score 5–6. Equivocal — further evaluation required.

→ Active observation. Consider ultrasound abdomen or CT scan. Serial assessment every 2–4 hours. Surgical review.

High Risk — Appendicitis Likely 7–10

Score 7–10. High probability of appendicitis. Positive predictive value ~80–90%.

→ Surgical review. Consider direct to theatre for high scores or CT confirmation. IV antibiotics pre-operatively. Appendicectomy.

Interpretation bands for the MANTRELS. Apply clinical judgement and local guidance.

Alvarado A. A practical score for the early diagnosis of acute appendicitis. Ann Emerg Med. 1986;15(5):557-564.
Ohle R et al. The Alvarado score for predicting acute appendicitis: a systematic review. BMC Med. 2011;9:139.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Drugs

Pathways

Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.