Background: Acute appendicitis is mostly considered a clinical diagnosis and many surgeons resort to clinical judgement for the deciding its management. Such cases often pose a diagnostic dilemma and result in significant negative exploration rates. Appendicitis Inflammatory Response (AIR) score, designed in 2008, is a validated clinical scoring system which has outperformed the well–known Alvarado scoring system. This study evaluates the risk stratification of patients as per AIR scores, correlation with the post–op histopathological examination (HPE) diagnosis to calculate the negative appendicectomy rate and to evaluate the diagnostic performance of this scoring system.

Method: This is a prospective observational study carried out between Nov 2016 and May 2018, on 150 cases of acute appendicitis that underwent surgical management.

Result: This study data revealed a negative appendicectomy rate of 9.33 %. Statistical analysis showed that scores of 9 – 12 has great accuracy for diagnosis, with a specificity of 100 % and positive predictive value of 1.0. whereas low scores of 0–4 potentially identifies cases who do not require surgery.

Conclusion: The AIR score is an accurate diagnostic tool when a score of 9 is taken as cut–off. Management algorithms based on AIR score have the potential of reducing negative appendicectomy rate by correct identification of those who don’t require surgery.