Purpose NELA scores are a commonly used tool to assess risk for patients undergoing emergency laparotomy (EL). Certain components of the score require a level of clinical judgement. We aimed to characterise the consistency between different clinicians calculating a NELA score. Methodology The first 100 patients undergoing EL in 2021 at our institution were retrospectively audited. Three independent reviewers calculated a NELA score. Individual components and the resulting score were recorded for each reviewer. Intraclass correlation (ICC) was used to assess level of agreement between reviewers when calculating a NELA score. Results ICC for overall NELA score was 0.80 representing good correlation between reviewers. There was poor agreement between reviewers for most of the subjectively assessed components of the NELA score with ICCs for ASA score, ECG, signs of respiratory disease, estimated intraoperative blood loss and degree of peritoneal soiling ranging from 0 to 0.39. There was good agreement between reviewers on number of operations in previous 30 days, likely presence of malignancy and presence of cardiac signs with ICCs ranging from 0.53 to 0.73. Conclusion Good correlation between overall NELA scores suggests reliability of NELA score use with different reviewers. Accuracy and agreement between NELA scores by different reviewers might be improved by education regarding the use of the tool, publication of more objective criteria or by the use of the tool by more senior clinicians.