Background: Diagnosis of acute appendicitis is usually made on the basis of clinical judgment and experience of the surgeon. It may sometimes become a challenge due to variability in presentation. It is not unusual for surgical residents & consultants to miss the diagnosis.

Aim: To evaluate the effectiveness of Alvarado score in making an accurate diagnosis of acute appendicitis and assessing its sensitivity at a tertiary care hospital, in Lahore, Pakistan.

Methods: A Prospective observational study was conducted at the department of Surgery, Ghurki Trust Teaching Hospital (GTTH). The data was collected from 117 patients on a self-designed proforma over a one-year period i.e., from 1^st January 2018 to 31^st December 2018 with the suspected diagnosis of acute appendicitis and who underwent surgery. The variables were evaluated with Alvarado scoring system to assess its effectiveness and sensitivity. The data was analyzed using SPSS vr 23.

Results: Demographic results showed 73(62.4%) males and 44(37.6%) female. The mean age was 23 years and most of the patient were in age group 11-20years 55(47%). Abdominal pain was the commonest feature found in all the patients followed by Nausea in 72% and migration of pain to Right Iliac fossa 60%. Complicated appendicitis was found as gangrenous (7.5%) and perforated (6%). 53% of the cases were performed by on-call team consisted of SRs and surgical residents.

Conclusion: Alvarado score is an effective scoring system in making an accurate diagnosis of acute appendicitis. It can be very useful in the prompt management of patients with equivocal features and in extreme of ages.

Keywords: Acute appendicitis, Clinical scoring, Alvarado score