Alvarado score

A number of clinical and laboratory based scoring systems have been devised to assist diagnosis. The most widely used is Alvarado score.


  • Migratory right iliac fossa pain 1 point
  • Anorexia 1 point
  • Nausea and vomiting 1 point


  • Right iliac fossa tenderness 2 points
  • Rebound tenderness 1 point
  • Fever 1 point


  • Leucocytosis 2 points
  • Shift to left (segmented neutrophils) 1 point

Total score 10 points

A score below 5 is strongly against a diagnosis of appendicitis, while a score of 7 or more is strongly predictive of acute appendicitis. In patients with an equivocal score of 5-6, CT scan is used in the USA to further reduce the rate of negative appendicectomy.