{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T17:21:01Z","timestamp":1792430461863,"version":"4.5.0"},"reference-count":30,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T00:00:00Z","timestamp":1774483200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T00:00:00Z","timestamp":1774483200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["World j. surg."],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Diagnosing acute appendicitis in children with intermediate Pediatric Appendicitis Score (PAS) values remains a major clinical challenge. In this diagnostic gray zone, clinical findings, laboratory markers, and imaging often provide conflicting information, leading to uncertainty and variable management strategies. The aim of this study was to identify predictive factors of true appendicitis in children presenting with suspected appendicitis and intermediate PAS scores.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a prospective observational study including children aged 2\u201314\u00a0years presenting with suspected appendicitis and a PAS of 4\u20136 at a tertiary referral center between January 2022 and October 2025.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 559 included children, 289 (51.7%) had true appendicitis. The mean age was 9.4\u00a0\u00b1\u00a02.5\u00a0years, and males accounted for 58.1% of the cohort. On multivariable analysis, positive ultrasound was the strongest independent predictor of appendicitis (OR 55.1; 95% CI 29.4\u2013103.2;\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.001), followed by localized right lower quadrant tenderness (OR 2.98;\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.003), white blood cell count &gt; 15\u00a0\u00d7\u00a010\n                      <jats:sup>9<\/jats:sup>\n                      \/L (OR 2.53;\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.003), and male sex (OR 1.99;\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.015). Ultrasound demonstrated excellent diagnostic performance, with a sensitivity of 94%, a negative predictive value of 93%, and an overall accuracy of 88%.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In children with intermediate PAS scores, ultrasound plays a central role in diagnostic decision\u2010making. Its strong rule\u2010out value allows meaningful risk reclassification, supporting safe observation while guiding timely surgical intervention when positive.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/wjs.70349","type":"journal-article","created":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T03:50:45Z","timestamp":1774583445000},"page":"1355-1362","source":"Crossref","is-referenced-by-count":1,"title":["Diagnostic Decision\u2010Making in Intermediate\u2010Risk Pediatric Appendicitis: A Prospective Cohort Study"],"prefix":"10.1002","volume":"50","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9491-816X","authenticated-orcid":false,"given":"Mohamed","family":"Zouari","sequence":"first","affiliation":[{"name":"Research Laboratory \u201cDevelopmental and Induced Diseases\u201d (LR19ES12) Faculty of Medicine of Sfax University of Sfax  Sfax Tunisia"},{"name":"Department of Pediatric Surgery Hedi Chaker Hospital  Sfax Tunisia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manel","family":"Belhajmansour","sequence":"additional","affiliation":[{"name":"Research Laboratory \u201cDevelopmental and Induced Diseases\u201d (LR19ES12) Faculty of Medicine of Sfax University of Sfax  Sfax Tunisia"},{"name":"Department of Pediatric Surgery Hedi Chaker Hospital  Sfax Tunisia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manar","family":"Hbaieb","sequence":"additional","affiliation":[{"name":"Research Laboratory \u201cDevelopmental and Induced Diseases\u201d (LR19ES12) Faculty of Medicine of Sfax University of Sfax  Sfax Tunisia"},{"name":"Department of Pediatric Surgery Hedi Chaker Hospital  Sfax Tunisia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asma","family":"Issaoui","sequence":"additional","affiliation":[{"name":"Research Laboratory \u201cDevelopmental and Induced Diseases\u201d (LR19ES12) Faculty of Medicine of Sfax University of Sfax  Sfax Tunisia"},{"name":"Department of Pediatric Surgery Hedi Chaker Hospital  Sfax Tunisia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oumaima","family":"Jarboui","sequence":"additional","affiliation":[{"name":"Research Laboratory \u201cDevelopmental and Induced Diseases\u201d (LR19ES12) Faculty of Medicine of Sfax University of Sfax  Sfax Tunisia"},{"name":"Department of Pediatric Surgery Hedi Chaker Hospital  Sfax Tunisia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahdi Ben","family":"Dhaou","sequence":"additional","affiliation":[{"name":"Research Laboratory \u201cDevelopmental and Induced Diseases\u201d (LR19ES12) Faculty of Medicine of Sfax University of Sfax  Sfax Tunisia"},{"name":"Department of Pediatric Surgery Hedi Chaker Hospital  Sfax Tunisia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Riadh","family":"Mhiri","sequence":"additional","affiliation":[{"name":"Research Laboratory \u201cDevelopmental and Induced Diseases\u201d (LR19ES12) Faculty of Medicine of Sfax University of Sfax  Sfax Tunisia"},{"name":"Department of Pediatric Surgery Hedi Chaker Hospital  Sfax Tunisia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,3,26]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/jpc.16748"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/wjs.70015"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s13312\u2010025\u201000217\u2010z"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s13312\u2010022\u20102620\u20104"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.4103\/ijpvm.ijpvm_539_21"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2352\u20104642(20)30006\u20107"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.31729\/jnma.8889"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2017\u20102699"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.2196\/67941"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.3390\/children7100176"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.3390\/medicina61071308"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/acem.70118"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1089\/sur.2023.295"},{"issue":"6","key":"e_1_2_11_15_1","first-page":"621","article-title":"Acute Abdominal Pain in Children: Evaluation and Management","volume":"110","author":"Buel K. 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