Introduction: Acute Appendicitis is one of the most common surgical emergencies and the most difficult to diagnose clinically in equivocal cases. Of the various clinical scoring systems, ALVARADO is the time tested scoring system. But the reliability of this scoring system among the Asian population has been debated. So we have compared the modified Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA), a score designed for the Asian population, to the ALVARADO scoring system in diagnosing acute appendicitis among the South Indian population. Aim: To compare the usefulness of modified RIPASA and Alvarado__ampersandsignrsquo;s scores in the diagnosis of acute appendicitis among the Indian population. Materials and Methods: The entire study population who presented to Sri Ramachandra Medical College and Research Insti tute, above the age of 18 years, with history and clinical features suggestive of acute appendicitis were scored with both Alvarado and Modified RIPASA scores. The modification done in the original RIPASA score for our study is the removal of the score for residential foreigner, as our study is based on the Indian population. The cut-off score to diagnose acute appendicitis in Modified RIPASA and ALVARADO was fixed at 7.5 and 7. Results: On comparing both the scores the sensitivity and specificity were higher for the Modified RIPASA score. This statistical significance is further backed up by the receiver operator curve (ROC) graph, which shows a larger area under the curve for Modified RIPASA (0.818) when compared to Alvarado (0.615). Conclusion: The Modified RIPASA, a simple and easy scoring system, shows promising results in a South Indian population with higher sensitivity and specificity than the ALVARADO score.