The MANTRELS (Alvarado) Score is a classic surgical tool used to evaluate patients presenting with acute abdominal pain, specifically evaluating the likelihood of acute appendicitis.
The Classic Presentation
Appendicitis typically follows a predictable clinical timeline, which the score mirrors. It often begins as vague pain around the belly button (umbilicus). The patient loses their appetite (anorexia) and may vomit. Over the next 12-24 hours, the inflammation spreads to the peritoneum, and the pain sharpens and migrates directly to the Right Lower Quadrant (RLQ). Pressing on the RLQ causes severe pain, and letting go suddenly causes even sharper pain (rebound tenderness).
M (1) + A (1) + N (1) + T (2) + R (1) + E (1) + L (2) + S (1)
Scoring Weights
Not all symptoms are created equal. The two most predictive factors of appendicitis are:
- RLQ Tenderness: 2 points.
- Leukocytosis (High WBC count): 2 points. All other symptoms and signs receive 1 point.