Objectives: To evaluate the role of RIPASA scoring system for diagnosis of acute appendicitis taking histopathology as gold standard. Study Design: Prospective Study. Setting: Department of General Surgery, Nishter Hospital Multan. Period: February 2016 to February 2017. Material & Methods: One hundred and sixty 160 patients were included in this study. Study was started after ethical approval from ethical board of institution and informed consent from patients was taken. Non probability consecutive sampling was used. Main outcome variables were sensitivity, specificity and diagnostic accuracy of RIPASA score. SPSS version was used to analyze data. P value ≤ 0.05 was considered as significant. Results: Estimated sensitivity was 97.9%, which means that of the patients with acute appendicitis, 97.9% were diagnosed correctly. The estimated specificity was 76.9%, which means that of the patients not having acute appendicitis, 76.9% were diagnosed correctly. Positive predictive value was 86.1% and negative predictive value was 96.2%. The overall accuracy was 89.4% for diagnosing acute appendicitis. Conclusion: RIPASA scoring system is efficient, reliable and more diagnostic in cases of acute appendicitis. Abdominal ultrasonography is not suitable diagnostic tool to rule out negative appendectomy.