Despite what is commonly believed, the diagnosis of acute appendicitis is not always easy. Proof of this is the high rate of negative appendicectomies performed yearly in any surgery unit. "Unnecessary" operations involve a huge waste of resources and are sometimes associated with severe complications. In an attempt to obtain a more accurate diagnosis many authors recommend the routine use of sophisticated investigations, which are not always non-invasive and sometimes fail to yield encouraging results. The aim of this study was to retrospectively analyse a group of patients with suspected appendicitis and establish whether certain clinical and instrumental parameters may improve the surgeon's management of such cases and reduce the misdiagnosis rate. Our false-positive rate is in line with those of other studies conducted with the routine use of advanced diagnostic tests without any waste of financial resources or increase in time to diagnosis. These data suggest the superiority of traditional guidelines, based on a careful clinical diagnosis and on common laboratory examinations and ultrasonography, while advanced investigations should be reserved for diagnosing the few ambiguous cases, which are generally confined to more elderly patients.
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