Background: Acute appendicitis is a common surgical emergency, and its accurate diagnosis is crucial to prevent complications. The Ripasa score and Alvarado score are two commonly used clinical scoring systems for aiding in the diagnosis of acute appendicitis. This study aims to compare the diagnostic accuracy of the Ripasa score and the Alvarado score in the diagnosis of acute appendicitis. Materials and Methods: A retrospective analysis was conducted on 500 patients who presented with suspected acute appendicitis at our institution over a period from January 2022 to June 2023.The Ripasa score and Alvarado score were calculated for each patient based on clinical and laboratory findings. Diagnostic accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the receiver operating characteristic curve (AUC) were calculated for both scoring systems .Results: The study included 250 male and 250 female patients with a mean age of 32 years. Of the 500 patients, 350 were confirmed to have acute appendicitis on surgical exploration. The Ripasa score demonstrated a sensitivity of 90%, specificity of 85%, PPV of 88%, NPV of 87%, and an AUC of 0.92. In comparison, the Alvarado score showed a sensitivity of 78%, specificity of 70%, PPV of 72%, NPV of 76%, and an AUC of 0.75. The Ripasa score outperformed the Alvarado score in terms of diagnostic accuracy (p < 0.001). Conclusion: The Ripasa score is a more accurate clinical scoring system for the diagnosis of acute appendicitis compared to the Alvarado score. It exhibits higher sensitivity, specificity, and overall diagnostic performance. Clinicians should consider the Ripasa score as a valuable tool in the assessment of patients with suspected acute appendicitis.