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
|Migration of pain to the right lower quadrant||1|
|Nausea or vomiting||1|
|Tenderness in the right lower quadrant||2|
* 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.
- 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]
Created May 14, 2015.