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Alvarado score

Compute the Alvarado 1986 MANTRELS score from caller-assigned findings, temperature, WBC, and neutrophil percent.

Also searched as

Alvarado score
MANTRELS
Alvarado appendicitis score
Alvarado 1986
MANTRELS score

LIVE $0.005 USDC GET /api/calc/alvarado

Markdown: /docs/alvarado.md · Canonical: https://magentlab.com/docs/alvarado

Not a medical device. Not a diagnosis, dose, or listing recommendation.

What it computes

Compute the Alvarado 1986 MANTRELS score from caller-assigned findings, temperature, WBC, and neutrophil percent.

When to use

When an agent needs the published Alvarado 1986 total and must not invent abdominal findings or treat the total as an operating-room protocol.

When not to use

Not a diagnosis or operating-room protocol. Original discussion used 1-4; score 0 is grouped with 0-4 and is not a diagnosis.
Findings are caller-assigned. magent does not examine the abdomen.
This is Alvarado 1986 (MANTRELS), not RIPASA and not the pediatric Appendicitis Score.

Formula

Alvarado (MANTRELS) = migration + anorexia + nausea_vomiting + 2*rlq_tenderness + rebound + (temperature_c >= 37.3) + 2*(wbc_ul > 10000) + (neutrophil_percent > 75); max 10; bands 0-4 / 5-6 / 7-10

Citation

Title: A practical score for the early diagnosis of acute appendicitis
Authors: Alvarado A
Source: Ann Emerg Med. 1986;15(5):557-564
DOI: 10.1016/S0196-0644(86)80993-3

Worked example

All findings absent

Given: anorexia=falsemigration=falsenausea_vomiting=falseneutrophil_percent=60rebound=falserlq_tenderness=falsetemperature_c=37.0wbc_ul=8000

Five flags false; temperature 37.0 < 37.3; WBC 8000 ≤ 10000; neutrophils 60 ≤ 75
Score = 0; band 0-4

Try

Opens the live endpoint. Unpaid browser requests show the paywall; agents should send Accept: application/json.

/api/calc/alvarado?migration=false&anorexia=false&nausea_vomiting=false&rlq_tenderness=false&rebound=false&temperature_c=37.0&wbc_ul=8000&neutrophil_percent=60

Full URL: https://api.magentlab.com/api/calc/alvarado?migration=false&anorexia=false&nausea_vomiting=false&rlq_tenderness=false&rebound=false&temperature_c=37.0&wbc_ul=8000&neutrophil_percent=60

Call

Expect HTTP 402 until you retry with PAYMENT-SIGNATURE. Incomplete query params return HTTP 400 before any quote or charge.

curl -i -H "Accept: application/json" "https://api.magentlab.com/api/calc/alvarado?migration=false&anorexia=false&nausea_vomiting=false&rlq_tenderness=false&rebound=false&temperature_c=37.0&wbc_ul=8000&neutrophil_percent=60"

Parameters

Name	Type	Required	Description
`migration`	boolean	required	Pain migration to the right lower quadrant (M). true or false.
`anorexia`	boolean	required	Anorexia (A). true or false.
`nausea_vomiting`	boolean	required	Nausea or vomiting (N). true or false.
`rlq_tenderness`	boolean	required	Right-lower-quadrant tenderness (T). true scores 2; false scores 0.
`rebound`	boolean	required	Rebound tenderness (R). true or false.
`temperature_c`	number	required	Temperature in °C (30.0-45.0). ≥37.3 scores 1 (37.3 scores; 37.2 does not).
`wbc_k_ul`	number	optional	WBC in 10^3/µL (same as 10^9/L). Provide wbc_k_ul or wbc_ul. Range 0.01-500. >10000/µL scores 2.
`wbc_ul`	number	optional	WBC in cells/µL (same as cells/mm^3). Provide wbc_k_ul or wbc_ul. Range 10-500000. >10000 scores 2 (10000 does not; 10001 does).
`neutrophil_percent`	number	required	Neutrophil percent (0-100). Left shift scores 1 if >75 (75.0 does not; 75.1 does).

Bulk (POST)

POST the same path with a JSON items array. Price is n times the GET unit. Invalid items return HTTP 400 before settlement.

POST /api/calc/alvarado Max 25 unit_amount * n PREVIEW

1 to 25 items. Each item uses the same keys as the GET query parameters.
The first invalid item fails the whole request (index in the 400 JSON). You are not charged.
HTTP 200 is {count, path, items}. Each items[i] is the GET 200 body for that row.
Catalog misses (empty matches, found=false) stay paid 200s inside that slot.
x402 resource URL is this path plus n and body_sha256. Browsers that prefer text/html get the same paywall as GET; Pay retries POST with the same items.

Example request (fixture)

{
  "items": [
    {
      "anorexia": "false",
      "migration": "false",
      "nausea_vomiting": "false",
      "neutrophil_percent": "60",
      "rebound": "false",
      "rlq_tenderness": "false",
      "temperature_c": "37.0",
      "wbc_ul": "8000"
    },
    {
      "anorexia": "false",
      "migration": "false",
      "nausea_vomiting": "false",
      "neutrophil_percent": "60",
      "rebound": "false",
      "rlq_tenderness": "false",
      "temperature_c": "37.0",
      "wbc_ul": "8000"
    }
  ]
}

Open bulk paywall →

Opens a two-item fixture on the API host. Unpaid browsers get the same MetaMask paywall as GET; Pay retries POST with those items.

Example 200 (fixture)

{
  "count": 2,
  "path": "/api/calc/alvarado",
  "items": [
    {
      "components": [
        {
          "factor": "migration",
          "points": 0,
          "present": false
        },
        {
          "factor": "anorexia",
          "points": 0,
          "present": false
        },
        {
          "factor": "nausea_vomiting",
          "points": 0,
          "present": false
        },
        {
          "factor": "rlq_tenderness",
          "points": 0,
          "present": false
        },
        {
          "factor": "rebound",
          "points": 0,
          "present": false
        },
        {
          "value": 37.0,
          "factor": "temperature_c",
          "points": 0,
          "present": false
        },
        {
          "value": 8.0e3,
          "factor": "leukocytosis",
          "points": 0,
          "present": false
        },
        {
          "value": 60.0,
          "factor": "left_shift",
          "points": 0,
          "present": false
        }
      ],
      "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.",
      "citation": {
        "authors": "Alvarado A",
        "doi": "10.1016/S0196-0644(86)80993-3",
        "id": "alvarado-1986",
        "source": "Ann Emerg Med. 1986;15(5):557-564",
        "title": "A practical score for the early diagnosis of acute appendicitis"
      },
      "formula": "alvarado",
      "formula_expression": "Alvarado (MANTRELS) = migration + anorexia + nausea_vomiting + 2*rlq_tenderness + rebound + (temperature_c >= 37.3) + 2*(wbc_ul > 10000) + (neutrophil_percent > 75); max 10; bands 0-4 / 5-6 / 7-10",
      "neutrophil_percent": 60.0,
      "max_score": 10,
      "score": 0,
      "alvarado_band": "0-4",
      "temperature_c": 37.0,
      "wbc_ul": 8.0e3
    },
    {
      "components": [
        {
          "factor": "migration",
          "points": 0,
          "present": false
        },
        {
          "factor": "anorexia",
          "points": 0,
          "present": false
        },
        {
          "factor": "nausea_vomiting",
          "points": 0,
          "present": false
        },
        {
          "factor": "rlq_tenderness",
          "points": 0,
          "present": false
        },
        {
          "factor": "rebound",
          "points": 0,
          "present": false
        },
        {
          "value": 37.0,
          "factor": "temperature_c",
          "points": 0,
          "present": false
        },
        {
          "value": 8.0e3,
          "factor": "leukocytosis",
          "points": 0,
          "present": false
        },
        {
          "value": 60.0,
          "factor": "left_shift",
          "points": 0,
          "present": false
        }
      ],
      "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.",
      "citation": {
        "authors": "Alvarado A",
        "doi": "10.1016/S0196-0644(86)80993-3",
        "id": "alvarado-1986",
        "source": "Ann Emerg Med. 1986;15(5):557-564",
        "title": "A practical score for the early diagnosis of acute appendicitis"
      },
      "formula": "alvarado",
      "formula_expression": "Alvarado (MANTRELS) = migration + anorexia + nausea_vomiting + 2*rlq_tenderness + rebound + (temperature_c >= 37.3) + 2*(wbc_ul > 10000) + (neutrophil_percent > 75); max 10; bands 0-4 / 5-6 / 7-10",
      "neutrophil_percent": 60.0,
      "max_score": 10,
      "score": 0,
      "alvarado_band": "0-4",
      "temperature_c": 37.0,
      "wbc_ul": 8.0e3
    }
  ]
}

Response

Field	Type	Description
`formula`	string	alvarado
`formula_expression`	string	Exact expression used
`score`	integer	Total points 0-10
`max_score`	integer	Always 10
`alvarado_band`	string	0-4, 5-6, or 7-10. Score 0 is grouped with 0-4; original discussion used 1-4.
`wbc_ul`	number	Normalized WBC in cells/µL used for scoring
`temperature_c`	number	Temperature in °C used for scoring
`neutrophil_percent`	number	Neutrophil percent used for the left-shift criterion
`components`	array	Per-factor MANTRELS points
`citation`	object	Alvarado 1986 citation
`disclaimer`	string	Not-a-device notice

Example JSON

Machine form of the same example. Frozen fixture. Not a live lookup.

{
  "components": [
    {
      "factor": "migration",
      "points": 0,
      "present": false
    },
    {
      "factor": "anorexia",
      "points": 0,
      "present": false
    },
    {
      "factor": "nausea_vomiting",
      "points": 0,
      "present": false
    },
    {
      "factor": "rlq_tenderness",
      "points": 0,
      "present": false
    },
    {
      "factor": "rebound",
      "points": 0,
      "present": false
    },
    {
      "value": 37.0,
      "factor": "temperature_c",
      "points": 0,
      "present": false
    },
    {
      "value": 8.0e3,
      "factor": "leukocytosis",
      "points": 0,
      "present": false
    },
    {
      "value": 60.0,
      "factor": "left_shift",
      "points": 0,
      "present": false
    }
  ],
  "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.",
  "citation": {
    "authors": "Alvarado A",
    "doi": "10.1016/S0196-0644(86)80993-3",
    "id": "alvarado-1986",
    "source": "Ann Emerg Med. 1986;15(5):557-564",
    "title": "A practical score for the early diagnosis of acute appendicitis"
  },
  "formula": "alvarado",
  "formula_expression": "Alvarado (MANTRELS) = migration + anorexia + nausea_vomiting + 2*rlq_tenderness + rebound + (temperature_c >= 37.3) + 2*(wbc_ul > 10000) + (neutrophil_percent > 75); max 10; bands 0-4 / 5-6 / 7-10",
  "neutrophil_percent": 60.0,
  "max_score": 10,
  "score": 0,
  "alvarado_band": "0-4",
  "temperature_c": 37.0,
  "wbc_ul": 8.0e3
}

Client errors (HTTP 400)

Invalid params return 400 without charge. Shared HTTP 402 and 503 meanings: Payments.

HTTP	Code	When
400	`invalid_flag`	boolean clinical flags must be true or false Returned before settlement; you are not charged.
400	`invalid_temperature`	temperature_c must be a number from 30.0 to 45.0. Returned before settlement; you are not charged.
400	`invalid_wbc`	wbc_k_ul (0.01-500) or wbc_ul (10-500000) is required Returned before settlement; you are not charged.
400	`invalid_neutrophil_percent`	neutrophil_percent must be a number from 0 to 100 Returned before settlement; you are not charged.
400	`invalid_items`	POST body must be a JSON object with only an items array Returned before settlement; you are not charged.
400	`invalid_item_count`	items must be an array of 1 to 25 objects Returned before settlement; you are not charged.
400	`invalid_item`	each items entry must be a JSON object Returned before settlement; you are not charged.

Related tools

Centor and McIsaac scores — Compute the Centor score or the McIsaac age-modified score from four caller-assigned pharyngitis findings. The edition is required.

Payment

Required query parameters must be present and valid. Invalid params return HTTP 400 JSON before settlement. magent does not charge. Fix the params, then request a new 402 quote for that complete URL. Catalog misses (empty matches, found=false) are valid paid 200s. Unpaid valid requests return HTTP 402 with a base64 PAYMENT-REQUIRED header. HTTP 503 is not a new quote: retry the same PAYMENT-SIGNATURE. Full handshake and shared payment errors: Payments. Stdio MCP: /docs/mcp.

Guarantees

Invalid query parameters return HTTP 400 before settlement. You are not charged.
Settlement finishes before the tool executes (paymentFlow upfront). Uncertain or failed settlement fails closed (HTTP 503). Retry the same PAYMENT-SIGNATURE.
HTTP 402 is unpaid only. Do not sign a second authorization because of a 503.
Execution is timeout-bounded and concurrency-capped.
Calculator inputs are stored encrypted for allowlisted operators (Magent Console). They are not in public logs, SSH lookups, catalog, or rollups. Request logs store path without query.