Alvarado Score for Appendicitis (MANTRELS)
Predicts likelihood of acute appendicitis using clinical and laboratory findings. MANTRELS mnemonic: Migration, Anorexia, Nausea/Vomiting, Tenderness, Rebound, Elevated temperature, Leukocytosis, Shift.
Score interpretation
→ Alvarado 7–10: High probability of acute appendicitis. Urgent surgical consultation; proceed to appendicectomy or CT if diagnosis unclear. Do not delay for imaging if signs are convincing.
→ Alvarado 5–6: Equivocal. CT abdomen/pelvis to confirm diagnosis; observe 6–12 hours; repeat assessment. Surgical review.
→ Alvarado 1–4: Low probability of appendicitis. Discharge with safety netting; return if worsening. Avoid unnecessary CT in young patients; USS as first-line imaging if required.
→ Alvarado 0: Very low probability of appendicitis. Consider alternative diagnoses (ovarian pathology, constipation, mesenteric adenitis, UTI).
Interpretation bands for the Alvarado Score. Apply clinical judgement and local guidance.
References
Related
Curated clinical cross-links plus same-class fallbacks.
- Methoxyflurane · Inhaled Analgesic — Acute Pain
- Morphine (Orthopaedic Acute Pain) · Opioid Analgesic — Strong
- Dexketoprofen (Acute Musculoskeletal Pain) · NSAID — Non-selective COX Inhibitor (S-enantiomer of Ketoprofen)
- Tranexamic Acid (ICU/Trauma/Surgical) · Antifibrinolytic
- Labetalol (IV — Hypertensive Emergency) · Combined Alpha-1 and Beta-Adrenergic Blocker
- Glyceryl Trinitrate (Sublingual / IV) · Nitrate / Acute Angina
- Major Trauma — Primary Survey (ATLS) · ATLS 10th Edition; JRCALC; NICE NG39
- Major Haemorrhage / Massive Transfusion · BCSH; RCOA; RCEM; RCS — BCSH Guidelines
- Burns — TBSA Estimation & Fluid Resuscitation · British Burn Association; EMSB; RCEM 2024
- Lower Gastrointestinal Bleed · NICE; BSG; ACPGBI — Commissioning Guide
- Acute Pancreatitis · NICE; IAP/APA; ACPGBI — CG104
- Hypertrophic Pyloric Stenosis · BAPS / RCPCH
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.