Alvarado's original MANTRELS score is a clinical prediction rule for suspected acute appendicitis, derived retrospectively in 305 hospitalised patients with abdominal pain suggestive of appendicitis.

Score	Risk band	Typical interpretation
0-4	Low probability	Appendicitis less likely. Many stable adults can be observed or investigated for alternative diagnoses.
5-6	Intermediate	Appendicitis possible. Close review, serial abdominal examination and imaging are usually appropriate.
7-10	High	Appendicitis likely. Urgent surgical review and imaging are recommended.

Evidence & context

The eight MANTRELS variables combine history, examination and full blood count findings into a 10-point score, with right lower quadrant tenderness and leukocytosis contributing two points each.
A systematic review of 42 validation studies found that a threshold below 5 is highly sensitive for appendicitis, making the score most useful as a low-risk triage aid.
At higher cutoffs, specificity is only moderate. High scores should still be combined with imaging, senior surgical assessment and the local appendicitis pathway.
Calibration is strongest in men. The score may over-predict appendicitis in women and children, so intermediate and high scores in these groups need particular caution.
MDCalc uses the same eight inputs and point weights. Contemporary reviews often discuss newer scores, but Alvarado remains a simple bedside triage tool.

Alvarado Score for Acute Appendicitis