Acute appendicitis is a common cause of right iliac fossa pain, necessitating accurate diagnostic tools to prevent unnecessary appendectomies. We compared the diagnostic efficacy of Appendicitis Inflammatory Response (AIR) and Alvarado scores in predicting perforated appendicitis cases. Negative appendectomies, estimated up to 17.5% in India, pose challenges, leading to prolonged hospital stays and increased costs. The study aimed to provide insights into effective diagnostic methods in clinical settings. Materials and Methods: Conducted in a tertiary care teaching hospital, the observational study included 120 surgically managed appendicitis patients. Inclusion criteria ensured a diverse patient cohort, while exclusion criteria streamlined participant selection. The study, spanning January to September 2023, incorporated specific cut-off scores for both scoring systems. Statistical analyses were performed using IBM SPSS Version 26.0. Results: The cohort predominantly comprised males (76.7%) with varying surgical procedures. Alvarado Score (>6) exhibited 85.45% sensitivity and 56.92% specificity, while AIR Score (>6) showed 76.36% sensitivity and 53.85% specificity. Both scores correlated with intra-operative findings, emphasizing their predictive potential. The Area Under the Curve (AUC) for Alvarado and AIR scores were 0.778 and 0.722, respectively, indicating good discriminatory capabilities. Conclusion:The Alvarado and AIR scores demonstrated differential diagnostic performances, emphasizing the trade-offs between sensitivity and specificity. AIR Score's superior AUC-ROC suggests enhanced differentiating capabilities