{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T06:47:09Z","timestamp":1792392429300,"version":"4.4.0"},"reference-count":35,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T00:00:00Z","timestamp":1792281600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T00:00:00Z","timestamp":1792281600000},"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."],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Unnecessary appendectomy (UA) remains an important quality indicator in pediatric emergency surgery, reflecting persistent diagnostic uncertainty despite advances in clinical assessment and imaging. The aim of this study was to identify predictors of UA in children.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>This investigation was designed as a prospective cohort study involving consecutive pediatric patients who underwent appendectomy for suspected acute appendicitis during January 2022 through December 2025. Unnecessary appendectomy was defined as the removal of a macroscopically and histologically normal appendix.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 653 children were included, of whom 53 (8.1%) underwent UA. The median age was 9.5\u00a0years, and males represented 66.8% of the cohort. Univariate analysis identified several factors potentially associated with UA. After adjustment for confounding variables, four factors remained independently associated with UA. These independent predictors included night\u2010time admission (OR 3.51; 95% CI 1.83\u20136.71;\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.001), a NLR below 5 (OR 3.12; 95% CI 1.60\u20136.12;\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.001), a CRP level below 10\u00a0mg\/L (OR 2.13; 95% CI 1.12\u20134.06;\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.021), and a negative US result (OR 5.67; 95% CI 2.98\u201310.76;\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Unnecessary appendectomy in children is influenced not only by clinical and biological variables but also by contextual factors related to the timing of presentation. Recognition of night\u2010time admission as a high\u2010risk context may support more cautious decision\u2010making strategies and help reduce avoidable surgical interventions in pediatric emergency care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/wjs.70640","type":"journal-article","created":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T06:30:32Z","timestamp":1792391432000},"source":"Crossref","is-referenced-by-count":0,"title":["Night\u2010Time Presentation as an Independent Predictor of Unnecessary Appendectomy in Children: A Prospective Cohort Study"],"prefix":"10.1002","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 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Tunisia"},{"name":"Department of Pediatric Surgery Hedi Chaker Hospital  Sfax Tunisia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed Karim","family":"Tounsi","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 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