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Home/Clinical calculators/Alvarado Score

Clinical calculator · Surgery and perioperative

Alvarado Score

Predicts likelihood of acute appendicitis

Highest activation tier
Mandatory
How it is scored
Scored in code; a detected disagreeing draft value is flagged for correction
Care settings
Emergency department

When it activates

Scribeable activates a calculator from the encounter. The Alvarado Score can activate when the transcript or pasted chart context documents any of these:

  • RLQ abdominal pain
  • Suspected appendicitis
  • Surgical consultation for appendicitis

A coded diagnosis can also activate it. ICD-10 prefixes carried by the registry: K35, K36, K37.

Note-type scope: it activates on notes whose subject resolves to emergency medicine, hospital medicine, gi. A note that resolves to another subject does not carry it even when the clinician's specialty matches; a note with no resolvable subject (a generic consultation) falls back to the specialty match.

Inputs the note needs

8 inputs. Each is resolved from the transcript, the pasted chart context and charted labs; an input marked "asks you" is requested as a clarification when it is undocumented.

InputTypeUnit / optionsGuidance
RLQ tendernessexam
Elevated temperaturevital
Rebound tendernessexam
Pain migration to RLQsymptom
Anorexiasymptom
Nausea/vomitingsymptom
WBC >10,000lab
Left shift (>75% neutrophils)lab

Reference for licensed clinicians. Where the registry text carries dose thresholds or conversion factors, they are as published in the cited sources. This page is not a prescribing tool and not individualised medical advice; verify against a current drug reference and the current guideline before acting. Medical disclaimer.

Scoring

RLQ tenderness=2, Leukocytosis=2, all others=1. Total 10.

Formula as the note renders it

2×RLQ tenderness RLQ tenderness + 2×Leukocytosis WBC >10,000 + Temp Elevated temperature + Rebound Rebound tenderness + Migration Pain migration to RLQ + Anorexia Anorexia + Nausea Nausea/vomiting + Left shift Left shift (>75% neutrophils)

Interpretation

<=2: Low risk, unlikely. 4-6: Equivocal, CT recommended. >=9: High probability, consider surgery.

Evidence

Sources carried in Scribeable's citation registry for this calculator.

  • Alvarado A. A practical score for the early diagnosis of acute appendicitisAlvarado (Appendicitis Score) 1986 · 1986 · link last verified 2026-03-23

How Scribeable handles it in the note

When an encounter activates the Alvarado Score at the mandatory tier, Scribeable resolves its inputs from the transcript, the pasted chart context and any charted labs, and asks you for a missing input you can supply before the note is finalised. Bedside-exam and separately ordered study values are not requested one input at a time; a calculator that carries a combined clarification question may still put that single question to you.

The score is computed in code from the resolved inputs, not recalled by the language model. If the draft states a Alvarado Score value that disagrees with the computed one, the disagreement is flagged to the second drafting pass, which is instructed to correct the score and its interpretation before you see the note.

Classified as a risk score: activated strictly, by a documented trigger, never by a permissive reading of the encounter.

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Can activate in: Emergency Medicine, Surgery.

Scored in code

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