BACKGROUND Traditional approach of high rate of negative appendicectomies is being questioned in today's era of cost-effective healthcare. The goal of surgical treatment is removal of an inflamed appendix before it goes in for complications with minimal number of negative appendicectomies. Because of the high morbidity of complicated appendicitis, prompt diagnosis and treatment is imperative. The aim of the study is to study the relation between Alvarado score and C-reactive protein in predicting severity of acute appendicitis. MATERIALS AND METHODS Study was conducted in Government Medical College, Calicut. All patients with clinical diagnosis of acute appendicitis presenting to surgery casualty, qualifying the inclusion criteria of the study were evaluated with routine investigations. Patients were informed regarding the study and consent obtained. RESULTS CRP cannot replace clinical diagnosis, but is an useful adjunct in predicting the severity of appendicectomies. It has been found that negative appendicectomies belonged to group with <7 Alvarado score and most of complicated appendicectomies had score >7. CONCLUSION Both Alvarado score and CRP are reliable indicators in predicting the severity of appendicitis. Comparing the two CRP is a better predictor of severity of acute appendicitis.