Alvarado / Pediatric Appendicitis Score
Alvarado / Pediatric Appendicitis Score - a deterministic tool in Sophie Well's Clinical Scoring & Risk group.
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What this is
Score Alvarado (MANTRELS) and the Pediatric Appendicitis Score (PAS) together for evaluating right-lower-quadrant pain. 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.
References
Alvarado A. Ann Emerg Med. 1986;15(5):557-564 (MANTRELS). Samuel M. J Pediatr Surg. 2002;37(6):877-881 (PAS).
Worked example: Alvarado 6 (compatible with appendicitis); PAS 4 (equivocal).
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