Purpose A surgeon is faced with rapid complex decision making regarding whether to provide operative intervention, when encountering a ruptured AAA. The Harbourview Risk Score (HRS), shows promise in calculating 30-day mortality 1–4. The. It scored 1 point for age (>76 y), pH (<7.2), SBP (<70 mmHg), Cr(>176.8 mol/L) 4. The aim of this study is to validate this scoring system, and the secondary aims are to assess outcomes between open (OR) and endovascular (EVAR) intervention for rAAA. Methodology A multi-centre retrospective data review was performed on patients who presented to hospital with a rAAA between 2018 and 2023. Demographic, comorbidity, clinical and biochemical data was collected. Analyses was carried out using SPSS and Prism. Results 104 patients (68% male, median [range] age 75.5 [48-97], 28% Indigenous Māori, 61% NZ European) were included in the study. Of 78 patients that were offered an intervention, 28 (36%) were EVAR. Based on the Kaplan-Meier analysis, the median survival for patients with an OR was 90 days, and 850 days for patients with an EVAR. In the OR group, there was a 50% 30-day mortality, compared to 22% for the EVAR group (p-value 0.005) (OR 4.6 (95% CI: 1.51-14.02). In our cohort, 30-day mortality was 14.3% in HRS 0, 39.5% in HRS 1, 65.7% in HRS 2, and 88.2% in HRS 3 and 4 points, which are similar to the results in the seminal paper. 4 The ROC-curve identified AUC of 0.7527 with a p-value of <0.0001 suggesting that the HRS is a good score to use for predicting 30-day mortality. Conclusion Retrospectively applied, HRS was validated in our multi-centre New Zealand study. HRS is a quick and easy tool at hand to risk stratify patients and should be considered as a useful adjunct for decision making. Given an improved short to mid-term survival in our setting, where possible, EVAR first strategies should be strongly considered. Long-term data is awaited.