Acute appendicitis continues to be one of the most prevalent surgical emergencies globally, presenting significant diagnostic challenges due to its diverse clinical manifestations. To standardize evaluation and enhance diagnostic accuracy, clinical scoring systems have been developed. Among the most commonly employed are the Alvarado score, the Pediatric Appendicitis Score (PAS), the Appendicitis Inflammatory Response (AIR) score, and the Adult Appendicitis Score (AAS). These instruments incorporate clinical signs, symptoms, and laboratory parameters to categorize patients based on the probability of appendicitis. Nevertheless, their diagnostic efficacy varies across different patient populations, including pediatric, adult, elderly, and pregnant cohorts. This review evaluates the validation and clinical applicability of various scoring systems, emphasizing their strengths and limitations across diverse patient groups. Overall, clinical scoring systems function as valuable adjuncts rather than standalone diagnostic tools. Their effectiveness is optimized when combined with clinical judgment and imaging techniques. Further refinement and population-specific validation are crucial to improving diagnostic precision and minimizing unnecessary surgical interventions.