Children with equivocal appendicitis are often unnecessarily admitted, leading to high rates of negative appendectomies.

• 54% of patients were admitted for observation after-hours, with 30% undergoing unnecessary appendectomies.
• An Alvarado score under 5 accurately ruled out appendicitis in all cases, yet 44% of these low-score patients were still admitted.

Discharging children with low Alvarado scores can optimize resource use and reduce unnecessary surgeries.

• Only 3% of discharged patients required follow-up surgery for appendicitis.