After the 2004 Indian Ocean tsunami catastrophe, UNESCO through the IOC (Intergovernmental Oceanographic Commission) sponsored the establishment of Intergovernmental Coordination Groups (ICG) with the aim to devise and implement Tsunami Warning Systems (TWSs) in all the oceans exposed to tsunamis, in addition to the one already in operation in the Pacific (PTWS). In this context, since 2005, efforts have begun for the establishment of TWSs in the Indian Ocean (IOTWS), in the Caribbean area (CARIBE EWS) and in the North Eastern Atlantic, the Mediterranean and Connected Seas (NEAMTWS). In this paper, we focus on a specific tool that was first introduced in the PTWS routine operations, i.e., the Decision Matrix (DM). This is an easy-to-use table establishing a link between the main parameters of an earthquake and the possible ensuing tsunami in order to make quick decision on the type of alert bulletins that a Tsunami Warning Center launches to its recipients. In the process of implementation of a regional TWS for the NEAM area, two distinct DMs were recently proposed by the ICG/NEAMTWS, one for the Atlantic and the other for the entire Mediterranean area. This work applies the Mediterranean NEAMTWS DM to the earthquakes recorded in Italy and compares the action predicted by the DM vs. the action that should be appropriate in view of the observed tsunami characteristics with the aim to establish how good the performance of the Italian TWS will be when it uses the DM for future events. To this purpose, we make use of the parametric catalogue of the Italian earthquakes (CPTI04) compiled in 2004 and the most recent compilation of the Italian tsunami, based on the Italian Tsunami Catalogue of 2004 and the subsequent revisions. In order to better compare the TWS actions, we have identified four different kinds of action coding them from 0 to 3 according to the tsunami severity and have further considered three different distance ranges where these actions apply, that is local, regional and basin-wide, that refer to the distance of the message recipients from the tsunami source. The result of our analysis is that the actions prescribed by the DM are adequate only in 45%–55% of the cases, overestimations are about 37% and underestimations are the rest. As a whole, the predictive ability of the DM is not satisfactory, which implies that recipients have the difficult task in managing bulletins carrying a great deal of uncertainty and on the other hand also suggests that strategies to improve the DM or to go beyond the DM need to be found.