Alvarado / Pediatric Appendicitis Score
Score Alvarado (MANTRELS) and the Pediatric Appendicitis Score (PAS) together for evaluating right-lower-quadrant pain.
Open the calculator → Runs in your browser. Data leaves only if you deliberately send a problem report from the interactive tool.
Example
- Alvarado: migration of pain to RLQ
- Yes
- Alvarado: anorexia
- Yes
- Alvarado: RLQ tenderness
- Yes
- Alvarado: leukocytosis
- Yes
- PAS: RLQ tenderness
- Yes
- PAS: migration of pain
- Yes
- PAS: leukocytosis
- Yes
Result: Alvarado 6 - equivocal (consider observation/imaging); PAS 4 - equivocal.
The tool opens with these values already filled in. Replace them with your own.
What the result means
- 1-4
- Appendicitis unlikely; discharge with follow-up may be appropriate per source.
- 5-6
- Compatible with appendicitis; observation or further evaluation per source.
- 7-10
- Appendicitis probable to very probable; surgical evaluation per source.
What you enter
- Alvarado: migration of pain to RLQ (1)
- Alvarado: anorexia (1)
- Alvarado: nausea / vomiting (1)
- Alvarado: RLQ tenderness (2)
- Alvarado: rebound tenderness (1)
- Alvarado: elevated temperature (1)
- Alvarado: leukocytosis (2)
- Alvarado: left shift (1)
The other 8 fields
- PAS: cough / hop / percussion tenderness (2)
- PAS: RLQ tenderness (2)
- PAS: migration of pain (1)
- PAS: anorexia (1)
- PAS: fever (1)
- PAS: nausea (1)
- PAS: leukocytosis (1)
- PAS: left shift (1)
What this is
Alvarado is an eight-item adult score - migratory pain, anorexia, nausea or vomiting, RLQ tenderness, rebound, fever, leukocytosis, and left shift - with totals stratifying as appendicitis unlikely, possible, probable, or very probable. PAS is an eight-item pediatric score (cough/percussion or hop pain replaces rebound; absent neutrophilia in lieu of left shift) calibrated for children 4-15. Sophie Well computes both from a shared inputs panel. Source: Alvarado A. Ann Emerg Med 1986;15:557-564; Samuel M. J Pediatr Surg 2002;37:877-881.
When to use it
Use this in the ED for a patient with suspected appendicitis to decide between discharge with return precautions, observation with serial exams, ultrasound or MRI as the first imaging study, or proceeding to CT and surgical consult. The scores are decision-support and not diagnostic - a low score in a well-appearing patient supports a non-imaging pathway, an intermediate score is the band where ultrasound or short-interval reassessment changes management, and a high score points toward imaging and surgical involvement up front. PAS is the score to favor in young children where CT exposure should be avoided unless ultrasound is non-diagnostic.
How this is calculated
Alvarado A. Ann Emerg Med. 1986;15(5):557-564 (MANTRELS). Samuel M. J Pediatr Surg. 2002;37(6):877-881 (PAS). Read the sources: Alvarado 1986 ↗, Samuel 2002 ↗
A reference and educational tool. Not medical, legal, or financial advice, and not a substitute for clinician judgment.