On my last shift three roughly equivalent appearing patients arrived in a two hour period all worried about appendicitis. The one who was least comfortable on arrival ultimately went home. The one who felt she was getting better over the last 3 days, and only felt pain with deep pressure over the appendix, went to the OR. The last one just got better over an hour with no meds and went home.
The more appy ultrasounds and CTs we order the less I feel like I can predict the outcome from my exam. I really feel for surgeons pre-CT who had to make the hard calls on exam alone. History, however, remains critical.