Alvarado Score for Acute Appendicitis

Diagnose appendicitis


The Alvarado score was developed to assist in diagnosing appendicitis.

Studies that look at the score's ability to rule out appendicitis (using Alvarado < 3-4) have a sensitivity of 96%. Studies that use the score to rule in appendicitis (using Alvarado > 6-7) have a sensitivity of 58-88%, depending on the study and score cutoffs used.

McKay et al. recommend a CT scan for a score of 4-6 and surgical consultation for a score ≥ 7. For a score of ≤ 3, the authors suggest that a CT scan is unnecessary for diagnosing appendicitis given the low likelihood of appendicitis.

A score is assigned by the following variables.

  • +2 points - Right lower quadrant tenderness
  • +1 point - Elevated temperature (>37.3°C or 99.1°F)
  • +1 point - Rebound tenderness
  • +1 point - Migration of pain to the right lower quadrant
  • +1 point - Anorexia
  • +1 point - Nausea or vomiting
  • +2 point - Leukocytosis > 10,000
  • +1 point - Leukocyte left shift


Alvarado A.

Annals of Emergency Medicine 1986, 15 (5): 557-64

The Alvarado Score for Acute Appendicitis calculator is created by QxMD.

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1. Right Lower Quadrant Tenderness?

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