Background:Appendicitis presents with pain in the right lower quadrant of the abdomen which radiates to other parts which varies with degree of inammation.1 It is one of the most common emergencies in surgery. The accurate diagnosis of acute appendicitis is approximately 70 to 87% and misdiagnosis are common which may result in occurrence of perforation 20% and negative appendectomy 2% to 30%.2 For diagnosis of acute appendicitis it depends on clinical history, presentation, examination and laboratory investigations along with early appendectomy can avoid complications arising from perforation, mass formation, peritonitis. Along with this Ultra sonogram is also tagged with the clinical examination in this condition3. Appendectomy is one of the most commonly performed surgical emergency operations which can mimic other acute conditions of the abdomen in the right iliac fossa pain mainly among the young, the elderly and females. Appendicitis is a common surgical condition in department of surgery, its diagnosis always doubtful and is mainly diagnosed with clinical presentation and laboratory investigation such as total leukocyte count, CRPetc. USG and CTAbdomen and Pelvis also have high sensitivity and specicity but is not cost effective hence results in delay of treatment leading to complication. To reduce such circumstances and to reduce the cost many scorings systems are introduced based on blood investigations, clinical presentation and radiological ndings are performed to diagnose this condition4. Raja IsteriPengiranAnakSaleha Appendicitis (RIPASA) 5, Alvarado6, Tzanakis 1 are most commonly used scoring systems to diagnose acute appendicitis. The aim of this study is to determine the accuracy of three scores in accurate diagnose of acute appendicitis by correlating them with the gold standard of histopathological conrmed appendicitis. Objectives: The objective was to compare the TZANAKIS,Raja IsteriPengiranAnakSaleha Appendicitis (RIPASA), Alvarado, scores in patients with right iliac fossa pain to diagnose acute appendicitis and obtain best scoring system out of these in RL jalappa hospital in cost effective way. Materials And Methods: A.Retrospective descriptive B.Total number of study subjects-135 All patients treated at the RLJalappa Hospital for acute appendicitis between January 2021 and April 2022 were identied through a computer-generated search through the Medical Records Department. Data were extracted retrospectively from hospital records. All patients were evaluated and graded using TZANAKIS, Raja IsteriPengiranAnakSaleha Appendicitis (RIPASA), Alvarado score. Conclusion TZANAKIS score was better in predicting appendicitis in RL Jalappa Hospital compared to other RIPASA and ALVARADO scoring system. It had better sensitivity and specicity than the other two scoring system. It overall reduced negative appendectomy rate and is cost effective with limited characteristics.