Background: This was a comparative study of modified Alvarado scoring and RIPASA scoring system in making diagnosis of acute appendicitis. Material and methods: The present cross-sectional, comparative study comprised of 50 patients presenting to the general surgery OPD and emergency department with RIF pain. All enrolled patients were informed regarding the study and their written consent will be obtained. The study protocol was approved from institutional ethical clearance committee. RIPASA was evaluated in all patients. Subjects having score of 7.5 and above were taken for surgical management. CT scanning was done among subjects with RIPASA score of 5 to 7 for confirmation of diagnosis. Patients with score of less than 5 were assessed for other etiologic factors responsible for abdomen pain. All subjects which were managed by conservative treatment were discharged. Diagnosis among surgically treated patients was confirmed through intra-op examination and by histopathological examining. Comparison of RIPASA and MASS was done. Results: While assessing the patients on the basis of RIPASA score, it was seen that in 88 percent patients, RIPASA score was ≥7.5 indicating presence of acute appendicitis. While assessing the patients on the basis of MAS, it was seen that in 80 percent patients, MAS was ≥7 indicating presence of acute appendicitis. Histopathology analysis revealed presence of appendicitis in 92 percent of the patients while it showed normal appendix findings in 8 percent of the patients. Conclusion: According to the current study, the RIPASA scoring system outperforms Alvarado scoring in terms of both sensitivity and specificity. Additionally, it has superior diagnostic precision, a high positive predictive value, and a high negative predictive value; as a result, the rate of negative appendicectomy is lower. It follows that the RIPASA scoring system may be used to more accurately assess cases of acute appendicitis, and that this method has the potential to be a more accurate and economical means of diagnosis.