Early Signs Appendicitis - Medical Algorithm

Patients with abdominal pain can be evaluated for acute appendicitis using a simple score based on clinical and laboratory findings.

Pneumonic: MANTRELS

Parameter	Findings	Points
symptoms	migration of pain	1
	anorexia and/or acetone in the urine	1
	nausea and vomiting	1
signs	tenderness in the right lower quadrant	2
	rebound pain	1
	elevation of temperature >= 37.3°C	1
laboratory	leukocytosis (WBC count > 10,000 per µL)	2
	shift to the left (neutrophils > 75% of differential)	1

(after Table 7, page 561)

where:

• Migration of pain: pain starting in the epigastrium or periumbilical area and in a few hours migrates to the right lower quadrant

• Tenderness in right lower quadrant: typically at McBurney's point

Interpretation:

• minimum score: 0

• maximum score: 10

Score	Interpretation
9 or 10	very probable acute appendicitis
7 or 8	probable acute appendicitis
5 or 6	compatible with acute appendicitis
0 to 4	acute appendicitis is unlikely

Management suggestions:

(1) If score is 5 or 6: observe

(2) If score is >=7: appendectomy indicated

(3) If score <= 4: evaluate for other causes of abdominal pain

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The Score of Alvarado for the Early Diagnosis of Acute Appendicitis