Alvarado Score Calculator for Acute Appendicitis

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Pain that began centrally or diffusely and then migrated to the right iliac fossa (McBurney point area). Worth 1 point.
Patient reports loss of appetite since the pain started. Documented subjectively or by failure to eat. Worth 1 point.
Nausea with or without vomiting since onset of abdominal pain. Worth 1 point.
Tenderness over McBurney point on physical examination. This is the most heavily weighted sign. Worth 2 points.
Pain that increases or appears on sudden release of deep pressure in the right lower quadrant. Worth 1 point.
Measured oral temperature of 37.3 °C (99.1 °F) or higher at presentation, as defined in the original Alvarado paper. Worth 1 point.
White blood cell count exceeding 10,000 per microlitre on a complete blood count. This is the most heavily weighted lab finding. Worth 2 points.
Neutrophilia greater than 75% of the total white cell count, indicating a shift toward immature granulocytes. Worth 1 point.
Alvarado ScoreHigh Risk
8/ 10

Total score from 0 (no criteria) to 10 (all criteria met)

Symptoms subtotal3pts
Signs subtotal3pts
Laboratory subtotal2pts
8 pts
Low Risk<5Intermediate5-7High Risk7+

Score 8/10: appendicitis is highly probable.

  • Scores of 7 or above correlate with a high probability of appendicitis. Published data suggest greater than 93% likelihood at scores of 9 or 10.
  • Early surgical consultation is appropriate. In many centres, a high Alvarado score combined with a convincing clinical picture supports proceeding to appendectomy without confirmatory CT in uncomplicated cases.
  • CT imaging may still be obtained to rule out perforation, abscess, or an unexpected alternative diagnosis before theatre.
  • The Alvarado score is a clinical aid and must be interpreted alongside the full history, examination, and local protocols. It does not replace physician judgment.

Next stepObtain urgent surgical review. Consider CT abdomen/pelvis if the diagnosis remains uncertain or if a complication such as perforation or peri-appendiceal abscess is suspected.

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