Unifying Concepts

Alvarado Score for Acute Appendicitis

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
Migration of pain to the right lower quadrant 1
Anorexia 1
Nausea or vomiting 1
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.



  1. Flum D. Acute Appendicitis: Appendectomy or the “Antibiotics First” Strategy. N Engl J Med. 2015 May 14;372(20):1937-43. [Medline]
  2. 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]
  3. Alvarado A. A practical score for the early diagnosis of acute appendicitis. Ann Emerg Med 1986;15:557-64. [Medline]


Created May 14, 2015.

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