Purpose: Diagnosing acute appendicitis often requires biochemical and imaging support which may not be feasible in low- and middle-income countries (LMICs). The APPEND score, developed in New Zealand, includes C-reactive protein (CRP) which in resource-limited settings, may be hindered by slow processing times. This study aims to evaluate a modified APPEND score (mAPPEND), excluding CRP for diagnosing appendicitis in a New Zealand Samoan cohort prior to evaluation in Samoa. Methodology: This secondary analysis utilized data from two cohorts (2011 and 2017) from Middlemore Hospital, Auckland. Patients aged ≥ 15 years with right iliac fossa pain for < 7 days were included, excluding those with prior appendicectomy or generalised peritonitis. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated, and diagnostic performance was assessed using receiver operating characteristic curve analysis, comparing the area under the curve (AUC) for both scores. Results: Among 53 Samoan patients, the AUC for the APPEND and mAPPEND scores were comparable (0.83 vs. 0.84 respectively, p = 0.57). The mAPPEND score demonstrated high diagnostic accuracy with scores of 0-2 showing 100% NPV and sensitivity, scores 4-5 showing 100% PPV and specificity, and a score of 3 being the most efficient with a sensitivity of 81% and specificity of 68%. Conclusion: The mAPPEND score, maintains high diagnostic accuracy for appendicitis in a New Zealand Samoan population. This modified score is a simple and viable tool in settings where CRP testing is unfeasible, supporting its use in Samoa and potentially other Polynesian people groups in the South Pacific.