Acute appendicitis during SARS-CoV-2: A brief communication of patients and changes in clinical practice from a single institute in Pakistan

Saleem, Ayesha; Sajid, Mir Ibrahim; Arshad, Muhammad

doi:10.1016/j.jpedsurg.2020.07.033

Cited by 6 publications

(9 citation statements)

References 1 publication

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“…A small number of recent reports suggest that such changes in the management of appendicitis are not unique to the UK but have been implemented in a number of countries. [11][12][13] Interestingly, over the course of this data collection period the proportion of cases undergoing nonoperative management decreased and the proportion of cases treated surgically having a laparoscopic procedure increased over time. We suspect this pattern is a reflection of initial guidance from professional bodies proposing non-surgical treatments be sought wherever possible and cautioning against the use of laparoscopy.…”

Section: Discussionmentioning

confidence: 99%

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Management and early outcomes of children with appendicitis in the UK and Ireland during the COVID-19 pandemic: a survey of surgeons and observational study

Bethell

Rees

Sutcliffe

et al. 2020

bmjpo

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ObjectivesAcute appendicitis is the most common surgical condition in children. In the UK, appendicectomy is the most common treatment with non-operative management unusual. Due to concerns about the risk of SARS-CoV-2 transmission during surgical procedures, surgeons were advised to consider non-operative treatment and avoid laparoscopy where possible. This study aims to report management and outcomes, to date, of children with appendicitis in the UK and Ireland during the COVID-19 pandemic.DesignSurvey of consultant surgeons who treat children with appendicitis that informed a prospective multicentre observational cohort study.SettingData were collected from centres in the UK and Ireland for cases admitted between 1 April and 31 May 2020 (first 2 months of the COVID-19 pandemic) at both general surgical and specialist paediatric surgical centres.ParticipantsThe study cohort includes 838 children with a clinical and/or radiological diagnosis of acute appendicitis of which 527 (63%) were male.Main outcomes measuredPrimary outcome was treatment strategy used for acute appendicitis. Other outcomes reported include change in treatment strategy over time, use of diagnostic imaging and important patient outcomes to 30 days following hospital admission.ResultsFrom very early in the pandemic surgeons experienced a change in their management of children with appendicitis and almost all surgeons who responded to the survey anticipated further changes during the pandemic. Overall, 326/838 (39%) were initially treated non-operatively of whom 81/326 (25%) proceeded to appendicectomy within the initial hospital admission. Of cases treated initially surgically 243/512 (48%) were performed laparoscopically. Diagnostic imaging was used in 445/838 (53%) children. Cases treated non-operatively had a shorter hospital stay than those treated surgically but hospital readmissions within 30 days were similar between groups. In cases treated surgically the negative appendicectomy rate was 4.5%. There was a trend towards increased use of surgical treatment and from open to laparoscopic appendicectomy as the pandemic progressed.ConclusionNon-operative treatment of appendicitis has been widely used for the first time in children in the UK and Ireland and is safe and effective in selected patients. Overall patient outcomes do not appear to have been adversely impacted by change in management during the pandemic thus far.

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Section: Discussionmentioning

confidence: 99%

“…A small number of recent reports suggest that such changes in the management of appendicitis are not unique to the UK but have been implemented in a number of countries. 11–13 …”

Section: Discussionmentioning

confidence: 99%

Management and early outcomes of children with appendicitis in the UK and Ireland during the COVID-19 pandemic: a survey of surgeons and observational study

Bethell

Rees

Sutcliffe

et al. 2020

bmjpo

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“…Hence, early diagnosis and appropriate treatment of AA in pediatric patients remain crucial to avoid associated complications. 50,62 Nevertheless, there were several authors who observed no significant differences in the number of children with complicated AA compared with previous years. 34,43,44,47,55 Based on data from a large German insurance company, the first COVID-19 lockdown resulted in a reduced number of pediatric appendectomies but not in an increased number of complicated AA, indicating that the confinement measures resulted in no deterioration of medical care for children with AA.…”

Section: Duration Of Appendicitis Symptoms Before Presentation During the Global Covid-19 Pandemicmentioning

confidence: 97%

“…As a general rule, some hospitals have newly adopted conservative treatment approaches for SARS-CoV-2 positive patients presenting with AA, particularly for non-complicated forms, whereas others continued to operate on all pediatric cases with AA. 43,46,51,62 The rationale for the latter is that most children with simple AA can be discharged home from the postanesthesia care unit shortly after the operation, whereas patients treated non-operatively require at least 24 hours in the hospital for intravenous antibiotics, which represent a longer time for patients and their family members being potentially exposed to SARS-CoV-2, and therefore an unnecessary use of hospital beds and medical resources. 65 Moreover, there seemed to be no reason to abandon laparoscopic appendectomy in favor of open surgery during the pandemic as SARS-CoV-2 was not detected in peritoneal fluid, thus reducing the theoretical possibility of viral transmission from aerosolization.…”

Section: Management Of Pediatric Appendicitis During the Global Covid-19 Pandemicmentioning

confidence: 99%

“…80 Since then, several single-center studies have been published reporting on children treated for AA during the initial COVID-19 lockdown, but only a very small proportion of them were confirmed positive for SARS-CoV-2 and none had any respiratory symptoms. 43,44,47,51,62 However, during the first peak of the COVID-19 outbreak in the New York City region, the novel virus was detected in a total of 11 pediatric patients with AA, one of which presented symptoms directly attributable to the SARS-CoV-2 infection. Interestingly, there were no differences in perforation rates or any other measured clinical parameters between those children with AA tested negative or positive for SARS-CoV-2.…”

Section: Management Of Pediatric Appendicitis Cases With Concomitant Covid-19mentioning

confidence: 99%

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Impact of the Global COVID-19 Pandemic on the Incidence, Presentation, and Management of Pediatric Appendicitis: Lessons Learned from the First Wave

2021

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The fast-evolving nature of the coronavirus disease 2019 (COVID-19) pandemic has led to unprecedented clinical, logistical, and socioeconomical challenges for health-care systems worldwide. While several studies have analyzed the impact on the presentation and management of acute appendicitis (AA) in the adult population, there is a relative paucity of similar research in pediatric patients with AA. To date, there is some evidence that the incidence of simple AA in children may have decreased during the first lockdown period in spring 2020, whereas the number of complicated AA cases remained unchanged or increased slightly. Despite a worrying trend toward delayed presentation, most pediatric patients with AA were treated expediently during this time with comparable outcomes to previous years. Hospitals must consider their individual capacity and medical resources when choosing between operative and non-operative management of children with AA. Testing for severe acute respiratory syndrome coronavirus type 2 is imperative in all pediatric patients presenting with fever and acute abdominal pain with diarrhea or vomiting, to differentiate between multisystem inflammatory syndrome and AA, thus avoiding unnecessary surgery. During the further extension of the COVID-19 crisis, parents should be encouraged to seek medical care with their children early in order that the appropriate treatment for AA can be undertaken in a timely fashion.

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Imaging pediatric acute appendicitis during the coronavirus disease 2019 (COVID-19) pandemic: collateral damage is variable

et al. 2021

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Background Since coronavirus disease 2019 (COVID-19) was declared a worldwide pandemic in March 2020, many authors have noted the collateral damage on non-COVID-19-related illnesses. These indirect effects of the pandemic have resulted in people presenting later and with more severe stages of disease, even if their diagnoses are not directly related to SARS-CoV-2, the virus that causes COVID-19. Objective We studied these indirect effects of COVID-19 on the imaging workup and outcomes for pediatric patients at our center who had acute appendicitis during the pandemic. Materials and methods We performed a retrospective review of cases in children ≤18 years who were evaluated for acute appendicitis during the same period, March 1 to May 31, in both 2019 and 2020. We compared demographic and clinical data as well as surgical and pathological findings, and we graded imaging findings according to severity. Differences in patient outcomes were assessed using the Wilcoxon rank sum test and the Pearson chi-square test. Results The total number of pediatric patients evaluated with imaging for acute appendicitis dropped by 43% between 2019 and 2020 (298 vs. 169), but the total number of children treated remained similar (59 vs. 51). There was proportionate use of US and CT in each timeframe but a higher percentage of positive imaging findings in 2020 (50/169, 29.6% vs. 56/298, 18.7% in 2019, P =0.04). There were more imaging examinations with features of complicated appendicitis among positive cases (9/51, 18% vs. 5/59, 8% in 2019, P =0.08) and more pathologically proven perforated cases during the pandemic (14/51, 27% vs. 6/59, 10% in 2019, P =0.11), although these results did not reach statistical significance. There were no changes in surgical management, vital signs, laboratory values, length of stay or complication rates. Conclusion There was a large drop in the number of pediatric patients imaged for acute appendicitis during the acute phase of the COVID-19 pandemic despite similar numbers of patients treated. The utilization trends of US vs. CT remained stable between time periods. The differences in imaging findings and perforation rates were less pronounced compared to other published studies.

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Acute appendicitis during SARS-CoV-2: A brief communication of patients and changes in clinical practice from a single institute in Pakistan

Abstract: The policies for managing pediatric surgery patients were developed by surgical and anesthesia teams collectively with consultations from our hospital's infectious diseases (ID) department, and the following principles were implemented:

Cited by 6 publications

References 1 publication

Management and early outcomes of children with appendicitis in the UK and Ireland during the COVID-19 pandemic: a survey of surgeons and observational study

Management and early outcomes of children with appendicitis in the UK and Ireland during the COVID-19 pandemic: a survey of surgeons and observational study

Impact of the Global COVID-19 Pandemic on the Incidence, Presentation, and Management of Pediatric Appendicitis: Lessons Learned from the First Wave

Imaging pediatric acute appendicitis during the coronavirus disease 2019 (COVID-19) pandemic: collateral damage is variable

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