Background: Acute appendicitis, a quotidian diagnosis for acute abdomen, the diagnosis of which remains arduous. Methods: A 70 consecutive patients suspected of acute appendicitis who were admitted in department of surgery, Rajah Muthiah Medical College and Hospital. They were prospectively assessed by the modified Alvarado scoring (MAS) to diagnose acute appendicitis. The MAS was compared with USG and histopathological findings. Results: (true positive) patients who had MAS 7 or more had appendicitis on histopathology while no patients (false positive) had a normal appendix; (false negative) patients with MAS less than 7 had appendicitis and (true negative)had a normal appendix removed. Conclusion: The MAS should be combined with USG for the diagnosis of acute appendicitis, although clinical evaluation remains the cornerstone of diagnosis of acute appendicitis