The use of the Alvarado scoring system, which includes clinical examination findings and laboratory values, is helpful in ruling out appendicitis. Scores range from 1 to 10, with higher scores indicating a greater risk of appendicitis. When the score is less than 4, appendicitis is uncommon, and imaging and other interventions can be avoided.
Alvarado Score for Acute Appendicitis
| Component Possible | Points |
| Symptoms | |
| Migration of pain to the right lower quadrant | 1 |
| Anorexia | 1 |
| Nausea or vomiting | 1 |
| Signs | |
| Tenderness in the right lower quadrant | 2 |
| Rebound pain | 1 |
| Elevated temperature | 1 |
| Laboratory findings | |
| Leukocytosis | 2 |
| Left shift† | 1 |
| Total score | 10 |
* Points are ascribed to each symptom, sign, and laboratory finding; patients with a score of less than 4 are unlikely to have appendicitis.
† A left shift is an increase in levels of immature neutrophil forms circulating in the peripheral blood.
References:
- Flum D. Acute Appendicitis: Appendectomy or the “Antibiotics First” Strategy. N Engl J Med. 2015 May 14;372(20):1937-43. [Medline]
- Ohle R, O’Reilly F, O’Brien KK, Fahey T, Dimitrov BD. The Alvarado score for predicting acute appendicitis: a systematic review. BMC Med 2011;9:139. [Medline]
- Alvarado A. A practical score for the early diagnosis of acute appendicitis. Ann Emerg Med 1986;15:557-64. [Medline]
- Kamal MM, Al Reshidi BM, Bedier HM, Albariqi AO, Almotrafie WA, Alshreef BS, Wahbi MO, Aly W, Alyami SA, Abdallah H, Alharbi SA. Diagnostic Accuracy of Point-of-Care Ultrasound (POCUS) for Suspected Acute Appendicitis in Pediatric and Adult Emergency Departments: A Systematic Review and Meta-Analysis. Cureus. 2026 Feb 12;18(2):e103503. [Medline]
Created May 14, 2015.
Up-date Mar 20, 2026.
