# Alvarado score Alvarado score ## Also searched as - Alvarado score - MANTRELS - Alvarado appendicitis score - Alvarado 1986 - MANTRELS score Status: LIVE Price: $0.005 USDC `GET /api/calc/alvarado` HTML: https://magentlab.com/docs/alvarado Markdown: https://magentlab.com/docs/alvarado.md 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 [A practical score for the early diagnosis of acute appendicitis](https://doi.org/10.1016/S0196-0644(86)80993-3) Alvarado A Ann Emerg Med. 1986;15(5):557-564 DOI: [10.1016/S0196-0644(86)80993-3](https://doi.org/10.1016/S0196-0644(86)80993-3) ## Worked example ### All findings absent Given: `anorexia=false, migration=false, nausea_vomiting=false, neutrophil_percent=60, rebound=false, rlq_tenderness=false, temperature_c=37.0, wbc_ul=8000` 1. Five flags false; temperature 37.0 < 37.3; WBC 8000 ≤ 10000; neutrophils 60 ≤ 75 2. Score = 0; band 0-4 ## Parameters - `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. Method: `POST /api/calc/alvarado` Max items: 25 Price: unit_amount * n (unit 5000 atomic) Status: 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: ```json { "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" } ] } ``` Human paywall (two-item fixture): https://api.magentlab.com/paywall/bulk/alvarado Example 200: ```json { "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", "max_score": 10, "score": 0, "alvarado_band": "0-4", "neutrophil_percent": 60.0, "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", "max_score": 10, "score": 0, "alvarado_band": "0-4", "neutrophil_percent": 60.0, "temperature_c": 37.0, "wbc_ul": 8.0e3 } ] } ``` ## Response fields - `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 Frozen fixture. Not a live lookup. ```json { "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", "max_score": 10, "score": 0, "alvarado_band": "0-4", "neutrophil_percent": 60.0, "temperature_c": 37.0, "wbc_ul": 8.0e3 } ``` ## Errors - HTTP 400 `invalid_flag`: boolean clinical flags must be true or false Returned before settlement; you are not charged. - HTTP 400 `invalid_temperature`: temperature_c must be a number from 30.0 to 45.0. Returned before settlement; you are not charged. - HTTP 400 `invalid_wbc`: wbc_k_ul (0.01-500) or wbc_ul (10-500000) is required Returned before settlement; you are not charged. - HTTP 400 `invalid_neutrophil_percent`: neutrophil_percent must be a number from 0 to 100 Returned before settlement; you are not charged. - HTTP 400 `invalid_items`: POST body must be a JSON object with only an items array Returned before settlement; you are not charged. - HTTP 400 `invalid_item_count`: items must be an array of 1 to 25 objects Returned before settlement; you are not charged. - HTTP 400 `invalid_item`: each items entry must be a JSON object Returned before settlement; you are not charged. Shared HTTP 402 and 503: https://magentlab.com/docs/payments ## Related tools - [Centor and McIsaac scores](https://magentlab.com/docs/centor) — 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. - GET the tool with Accept: application/json (do not send Accept: text/html unless you want the human paywall). - HTTP 402 means you have not paid. Decode the base64 PAYMENT-REQUIRED header. HTTP 503 is not a new quote. - Sign EIP-3009 (scheme exact, assetTransferMethod eip3009) with validBefore = now + accepts[0].maxTimeoutSeconds (600 seconds). That window starts when you sign and must cover wallet confirmation plus CDP verify and settle. Magent retries transient facilitator 429/5xx before answering. Do not send upto or batch-settlement payloads; magent does not offer those schemes. - Retry the same URL with PAYMENT-SIGNATURE (base64 JSON echoing accepted, payload, and extensions when present). - Success is HTTP 200 JSON plus PAYMENT-RESPONSE. Settlement happens before the tool runs. HTTP 503 settlement_uncertain or settle_failed: retry the same PAYMENT-SIGNATURE. Mint a new nonce only after a new HTTP 402. - offered `exact` on eip155:8453: Fixed-price USDC on Base. The buyer authorizes the advertised amount (EIP-3009). magent settles before the tool runs (paymentFlow upfront). extra.assetTransferMethod=eip3009 extra.paymentFlow=upfront. - not offered `upto`: Not offered. Usage-based: buyer authorizes a ceiling, seller settles the actual amount after work. Reserved for a future metered tool. Not for current calculators or code search. - not offered `batch-settlement`: Not offered. Payment-channel vouchers claimed later in batches. Not the same as POST {items} bulk (that is still exact). Same-path POST {items} is still scheme exact: one EIP-3009 authorization for n times the GET unit. That is not x402 batch-settlement (payment channels / vouchers). Shared HTTP 402 and 503 table: https://magentlab.com/docs/payments Stdio MCP (one process per host): https://magentlab.com/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.