Background and aims: Accurate diagnosis of acute appendicitis is challenging despite advances in modern radiodiagnosis and laboratory investigations. The Alvarado score is a numerical scoring system for the signs and symptoms associated with acute appendicitis. This scoring system was modified to exclude neutrophils as a parameter. Ultrasonography (USG) is an essential and routine diagnostic tool for diagnosing acute appendicitis. The study aims to determine the diagnostic accuracy of ultrasonography compared to the modified Alvarado score for the diagnosis of acute appendicitis. Methods: A prospective observational study of 43 patients who underwent appendectomy for suspected acute appendicitis at Jorhat Medical College and Hospital was done by collecting the patients’ clinical, radiological, and ultrasonographic data. Any patient who presented with suspected acute appendicitis at the Jorhat Medical College and Hospital was included in the study. The exclusion criteria were patients with a different diagnosis
at the end of the evaluation and patients who voluntarily opted out of the study. These patients were evaluated by modified Alvarado score and ultrasonography, and the findings correlated with histopathological reports. Results: Eighteen patients are males, and twenty-five patients are females. Most patients belong to the rural population (58.1%). Out of the total study population, 3 cases had no appendicitis by modified Alvarado and USG, 10 cases showed appendicitis on modified Alvarado score, 14 cases showed appendicitis on USG  and 16 cases on both. The results are not statistically significant (p>0.05). Conclusion: Combining ultrasonography and the modified Alvarado score