Objective Although acute appendicitis is the most common emergency surgical pathology it is not easy to diagnose in pediatric patients. This study aims to compare the accuracy of Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) and Alvarado scores in the diagnosis of acute appendicitis in children. Methodology Demographic data, examination findings, leukocyte count, neutrophil percentage, urine analysis and radiology reports of 163 consecutive patients who were underwent surgery for acute appendicitis were recorded. RIPASA and Alvarado scores of patients were calculated prospectively. Cutoff value was >7.5 for RIPASA score , ≥7 for Alvarado score. The accuracy of the diagnosis was confirmed by the histopathology result. The accuracy, sensitivity, specificity, positive predictive value, negative predictive value, area under the ROC curve of the RIPASA vs. Alvarado scores were evaluated. Results Negative appendectomy rate was 11.1%. The accuracy rate was 76.1% in the RIPASA score vs. 68.7% in the Alvarado score. The sensitivity and specificity values were 77.9%, 61.1% for RIPASA score vs. 68.2%, 72.2% for Alvarado score, respectively. Positive predictive value was 94.1% and negative predictive value was 25.5% for RIPASA score vs. 95.1%, 22.1%, respectively for Alvarado score. The area under the ROC curve was 0.74 for RIPASA score vs. 0.68 for Alvarado score, with no statistically significant difference between the two scores (p> 0.05). Conclusions RIPASA and Alvarado scores are not superior to each other in the diagnosis of acute appendicitis in children. Clinical examination, laboratory and radiology were more valuable in the diagnosis of acute appendicitis in children.