Abstract Background & Objectives -Acute appendicitis is one of the most common causes of acute abdominal pain requiring emergency surgical intervention. Despite advancements in imaging techniques, clinical scoring systems such as the Alvarado Scoring System and the RIPASA Scoring System remain essential diagnostic tools, particularly in resource-limited settings. This study aims to compare the diagnostic value, sensitivity, and specificity of the Alvarado and RIPASA Scoring Systems in patients presenting with right iliac fossa pain suspected of acute appendicitis. Materials & Methods: This hospital-based observational study was conducted at Gulbarga Institute of Medical Sciences over 18 months (May 2023 – October 2024). A total of 170 patients presenting with right iliac fossa pain were included. Patients were assessed using both the Alvarado and RIPASA scoring systems, and their scores were compared with histopathological confirmation of appendicitis. Statistical analysis was performed using sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) to evaluate the diagnostic accuracy of each scoring system. Results: The study revealed that the RIPASA Score demonstrated higher sensitivity (94%) compared to the Alvarado Score (72.8%), indicating better diagnostic accuracy. The specificity of the RIPASA Score was 88%, whereas the Alvarado Score had a specificity of 100%, suggesting that Alvarado is more effective in ruling out non-appendicitis cases. The positive predictive value (PPV) for both scores was 100%, meaning that a high score reliably indicated appendicitis, whereas the negative predictive value (NPV) was higher for RIPASA (90.7%) than for Alvarado (70.5%), indicating that RIPASA is more effective in identifying true-negative cases. Conclusion: This study confirms that the RIPASA Score is superior to the Alvarado Score in diagnosing acute appendicitis, particularly in Asian populations, due to its higher sensitivity and diagnostic accuracy. However, the Alvarado Score remains a valuable tool, particularly for ruling out non-appendicitis cases.