Background & Method: The aim of this study is to compare of acute inflammatory response and ALVARADO scoring system for diagnosis of acute appendicitis: a prospective and observational study. All patient undergone routine laboratory and ultrasound investigation. No CT scan was done for any of the patient. Surgical residents calculated the results of the Alvarado & AIR scoring system, and data were entered in pre-prepared forms. The specialist surgeon on duty decided to operate on admitted patients. Histopathology samples were sent for confirmation of acute appendicitis, the results were correlated with preoperative scores. Result: The present study included 100 patients with suspicion of appendicitis. There were 54% males and 46%) of females with male preponderance in the study. The mean age of the male was 34 years with a range of 7-84 years and female was 31 years with a range of 12-74 years. The most common age group in the study was 16-25 years (34%) followed by 26-35 years (28%). In the study, 38 cases of 100 (38%) were diagnosed pathologically as appendicitis Conclusion: To conclude, AIR scoring performed well almost equally with Alvarado system with high specificity and high negative predictive value preventing unnecessary negative appendectomies. Follow up of these cases will help in deciding surgical intervention in unnecessary cases. It has high specificity when analyzing patients who fell under low-risk group (score < 8). The score has high negative predictive value there by reducing negative appendectomies. This scoring system also prevents unnecessary and costly radiological investigations thereby reducing the financial burden to the patients.