Balancing Between Negative Appendectomy and Complicated Appendicitis: A Persisting Reality Under the Rule of the...

Uncertainty is inherent in medical practice. False-negative decisions can delay treatments and result in adverse outcomes in children with acute appendicitis (AA). On the other hand, false-positive surgery decisions lead to unnecessary appendectomies. Impressive technological advancements, such as magnetic resonance imaging and laparoscopy, have reduced but failed to eliminate the occurrence of erroneous decisions. Furthermore, there seems to be a fundamental limit to further reduction, especially in eliminating the rates of negative appendectomy or, oppositely, complicated appendicitis. What does this mean for the pediatric surgeon? Will we ever be able to eliminate our mistakes? This systematic review emphasizes the importance of understanding the potential abilities and limitations of different diagnostic options, as well as the impact of decisions in the face of uncertainty.