Background: Acute appendicitis is the acute inflammation of the appendix. It is surgical emergency, which is associated with morbidity and mortality occasionally. There are many scoring systems for the diagnosis of acute appendicitis, of these Alvarado score is simple scoring system that can be instituted easily in outpatient setting. It is purely based on history, clinical examination and few laboratory tests. The objectives of the study were to evaluate efficacy of Alvarado scoring system in preoperative diagnosis of acute appendicitis and correlating it with postoperative findings. Material and Methods: A prospective study was conducted on 45 patients presenting with symptoms and signs of acute appendicitis at Dr. Vasantrao Pawar Medical College, Nashik from August 2014 to December 2016. The patient who met the inclusion criteria were evaluated using Alvarado scoring system. Result: In present study 45 cases with a clinical diagnosis of acute appendicitis were studied. Majority (44.44%) were in the age group of 21-30 years. In this study, 24 patients (53.33%) were male and 21 patients (46.67%) were female with male to female ratio (1.1:1). Pain was the most common presenting symptom (100%). Out of 45 patient 34 patients (75.56%) have score >7 and 11 patient (24.44%) have score <7 and among these 38 patients (84.44%) got operated. Appendix was inflamed in 63.16% cases. Conclusions: Alvarado scoring system is an easy, simple, cheap, reliable and safe tool in pre operative diagnosis of acute appendicitis and can work effectively in routine practice.