Background: The diagnosis of acute appendicitis usually follows a direct approach. Despite the development of many appendicitis scores, the negative appendectomy is still problematic. Objectives: The aim of this study was to compare RIPASA score versus pediatric appendicitis score (PAS) for the diagnosis of acute appendicitis in children. Methods: One hundred and fifty-four pediatric patients aged from 1 to 14 years old were enrolled in this study. All of which presented to the emergency Department with symptoms suggestive of acute appendicitis. The patients were analyzed using the RIPASA and PAS on admission. The cut off threshold score proposed for RIPASA score and PAS were 7.5 and 6 respectively. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy were reported and compared based on correlation between the preoperative score and histopathological assessment. Results: The cut-off threshold score proposed for RIPASA score and PAS was 7.5 and 6 respectively. At this cut off score, the sensitivity, specificity, PPV, NPV and diagnostic accuracy of RIPASA score were 97.1%, 75%, 97%, 75% and 94.8% respectively. While those of PAS were 95.9%, 80%, 95%, 83% and 92.1% respectively. Conclusion: RIPASA score and PAS) were reliable and feasible clinical scoring systems for diagnosis of acute appendicitis in children.