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.
| Input | Type | Unit / options | Guidance |
|---|---|---|---|
| RLQ tenderness | exam | ||
| Elevated temperature | vital | ||
| Rebound tenderness | exam | ||
| Pain migration to RLQ | symptom | ||
| Anorexia | symptom | ||
| Nausea/vomiting | symptom | ||
| WBC >10,000 | lab | ||
| Left shift (>75% neutrophils) | lab |
Scoring
RLQ tenderness=2, Leukocytosis=2, all others=1. Total 10.
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.
See it activate on your own encounter
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