What does MANTRELS stand for?

MANTRELS is a mnemonic for the eight criteria: Migration of pain, Anorexia, Nausea/vomiting, Tenderness in the RLQ, Rebound pain, Elevated temperature, Leukocytosis, and Shift of WBC to the left.

What score threshold suggests surgery?

A score of 7 or higher is commonly used to indicate high probability of appendicitis and may warrant surgical consultation or appendectomy, though this is always paired with clinical judgment and imaging results.

Is the Alvarado score validated for children?

The original score was derived in adults. In children, modified versions such as the Pediatric Appendicitis Score (PAS) are often preferred, though the Alvarado score is still used with caution in pediatric practice.

What is a score of 5–6 interpreted as?

Scores of 5–6 fall in an equivocal range. These patients typically require further workup such as ultrasound or CT scan before a surgical decision is made.

Can a negative score rule out appendicitis?

A score of 1–4 suggests low probability, but appendicitis cannot be definitively excluded on score alone. Clinical re-evaluation and imaging may still be warranted if the clinical picture is concerning.

Alvarado Appendicitis Score

Name: Alvarado Appendicitis Score
Availability: InStock
Author: Nham Vu

Enter clinical findings to compute the Alvarado (MANTRELS) score and get an appendicitis risk interpretation (0–10).

Clinical Criteria

Check each finding present in the patient. Weighted items are marked with their point value.

Migration of pain to RLQ

Pain that started around the umbilicus and moved to right lower quadrant

Anorexia

Loss of appetite since symptom onset

Nausea or vomiting

Present at any point during the current illness

Tenderness in RLQ

Right lower quadrant tenderness on palpation (McBurney's point)

Rebound tenderness

Pain on release of deep palpation in RLQ (peritoneal sign)

Elevated temperature ≥ 37.3 °C (99.1 °F)

Low-grade or higher fever at time of assessment

Leukocytosis WBC ≥ 10,000 / µL

Elevated white blood cell count on CBC

Left shift (neutrophilia / bands)

Increased neutrophil count or band forms on differential

Score & Interpretation

out of 10

Score 0 — Select criteria above

Check clinical findings to calculate the Alvarado score.

Score Reference

1–4: Low probability — appendicitis unlikely

5–6: Equivocal — further workup recommended

7–8: Probable appendicitis — surgical consultation

9–10: Very high probability — likely appendicitis

For clinical decision support only. Does not replace physician assessment, imaging, or laboratory correlation.

Summary

Enter clinical findings to compute the Alvarado (MANTRELS) score and get an appendicitis risk interpretation (0–10).

How it works

Check each clinical criterion that is present in the patient.
The score adds: migration of pain to RLQ (1), anorexia (1), nausea/vomiting (1), RLQ tenderness (2), rebound tenderness (1), elevated temperature ≥37.3 °C (1), leukocytosis WBC ≥10,000 (2), and left shift neutrophils (1).
Scores 1–4 suggest low risk; 5–6 suggest possible appendicitis; 7–8 suggest probable appendicitis; 9–10 strongly suggest appendicitis.
A score ≥7 is the commonly used surgical threshold in adults.

Use cases

Emergency physicians scoring patients presenting with acute right lower quadrant pain.
Surgical residents performing a rapid initial assessment before imaging.
Medical students learning the MANTRELS criteria for appendicitis evaluation.
Nurses documenting triage risk stratification for abdominal pain patients.

Frequently Asked Questions

Last updated: 2026-07-01 · Reviewed by Nham Vu