Calculators & Tools

Alvarado Score (MANTRELS)

Classic clinical score for the likelihood of acute appendicitis.

1 What is the Alvarado Score (MANTRELS)?

The Alvarado Score (MANTRELS) is a GI & Liver scoring tool used in paediatric practice. Classic clinical score for the likelihood of acute appendicitis. It scores 8 criteria and interprets the total across 4 bands, so the number always arrives with the severity it implies rather than on its own. In PediAid each criterion is shown as a labelled option with the weight it carries, so the total can be checked rather than taken on trust.

2 When to use it

  • Grading severity at the bedside in GI & Liver
  • Recording an objective severity band in the case notes
  • Deciding when a total crosses the threshold for escalation
  • Re-scoring to track whether a child is improving or deteriorating
  • Checking the exact criteria of a score used infrequently

3 Formula & method

The score sums 8 criteria: Migration of pain to RLQ; Anorexia; Nausea or vomiting; Tenderness in RLQ; Rebound pain; Elevated temperature ≥ 37.3 °C; Leucocytosis > 10 000 /µL; Shift to the left (neutrophils > 75 %). Totals are then banded: any score - Unlikely: score 0-4 - appendicitis unlikely. Consider discharge with safety-netting or an alternative diagnosis; 5 points or more - Possible: score 5-6 - compatible with appendicitis. Observation and/or imaging recommended; 7 points or more - Probable: score 7-8 - probable appendicitis. Surgical referral; 9 points or more - Very probable: score 9-10 - very probable appendicitis. Urgent surgical referral.
  • Total range 0-10. Less well validated in young children than the Paediatric Appendicitis Score.
  • Source: Alvarado A. A practical score for the early diagnosis of acute appendicitis. Ann Emerg Med 1986;15:557-64.

4 Frequently asked questions

How many criteria does the Alvarado Score (MANTRELS) use?

8. They are Migration of pain to RLQ; Anorexia; Nausea or vomiting; Tenderness in RLQ; Rebound pain; Elevated temperature ≥ 37.3 °C; and others.

What do the bands of the Alvarado Score (MANTRELS) mean?

The total is interpreted as: any score - Unlikely: score 0-4 - appendicitis unlikely. Consider discharge with safety-netting or an alternative diagnosis; 5 points or more - Possible: score 5-6 - compatible with appendicitis. Observation and/or imaging recommended; 7 points or more - Probable: score 7-8 - probable appendicitis. Surgical referral; 9 points or more - Very probable: score 9-10 - very probable appendicitis. Urgent surgical referral.

Does the score replace clinical judgement?

No. It is a structured way to record and communicate severity. A clinician concerned about a child should act on that concern regardless of the total.

Where does this score come from?

Total range 0-10. Less well validated in young children than the Paediatric Appendicitis Score.

Does it work offline?

Yes. Score definitions are bundled with the PediAid app, so the score computes without a connection.

For qualified clinicians. This page and the PediAid app are a clinical aid only. Calculations and reference data must be verified against the patient's clinical context, the source guideline and your local protocols before any treatment decision is made.