Background: In acute appendicitis, decision‐making around operative intervention for paediatric patients differs from adults due to a higher weight placed on clinical assessment and reduced rates of cross‐sectional imaging. In regional settings, non‐paediatric emergency doctors, general surgeons, and radiologists usually assess and manage this patient group. Differences have been observed in paediatric negative appendicectomy rates between general and paediatric centres. Methods: A retrospective cohort study was performed, identifying paediatric patients undergoing emergency appendicectomy at the Southwest Health Campus (Bunbury, Western Australia) from 2017 to 2021. The primary outcome measure was histopathology confirming the absence of transmural inflammation of the appendix. In addition, clinical, biochemical and radiological data were collected to identify predictors of negative appendicectomy (NA). Secondary outcome measures were hospital length‐of‐stay and post‐operative complication rates. Results: Four hundred and twenty‐one patients were identified, of which 44.9% had a negative appendicectomy. Statistically significant associations between female gender, white cell count less than 10 × 109, neutrophil ratio less than 75%, low CRP and NA were observed. NA was not associated with a lower risk of re‐admission or complications compared with appendicectomy for appendicitis. Conclusions: Our centre's NA rate is higher than that observed in the literature at both non‐paediatric and paediatric surgical centres. NA has similar morbidity risk to appendicectomy for uncomplicated appendicitis and offers a timely reminder that diagnostic laparoscopy in children is not benign. [ABSTRACT FROM AUTHOR]