Appendicitis in Children in a Large Italian COVID-19 Pandemic Area

Pergola, Enrico La; Sgrò, Alberto; Rebosio, Federico; Vavassori, Daniele; Fava, G.; Codrich, Daniela; Montanaro, Beatrice; Leva, Ernesto; Schleef, Jürgen; Cheli, Marta; Pelizzo, Glória; Gamba, Piergiorgio; Alberti, Daniele; Betalli, Pietro

doi:10.3389/fped.2020.600320

Cited by 35 publications

(47 citation statements)

References 8 publications

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“…The available data regarding the influence of COVID-19 associated curfew measures on pediatric appendicitis is far from conclusive with some centers reporting an increase of pediatric and adult appendicitis during the corona pandemic (8) while others showed a marked decrease (9, 10) or no significant changes (11). Already early on during the pandemic the first report of a delayed diagnosis in a small group of pediatric patients with complicated appendicitis was published (12).…”

Section: Discussionmentioning

confidence: 99%

Increased Incidence of Perforated Appendicitis in Children During COVID-19 Pandemic in a Bavarian Multi-Center Study

et al. 2021

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Introduction: Since early 2020 the COVID-19 pandemic and statutory preventive reorganization of treatment capacities with cancellation of elective surgery as well as curfew regulations led to vastly decreased utilization of primary health care.Materials and Methods: To assess whether there are negative effects on pediatric acute care in Bavaria during the spring 2020 lockdown a state-wide retrospective multi-center study was performed to analyze the rate of perforated appendicitis during lockdown. Children who have been operated on during the corresponding period in 2018/19 served as control group.Results: Overall, 514 patients (292 boys, 222 girls) were included (2020: 176 patients; 2019: 181 patients; 2018: 157 patients). Median age was 11.2 years. Four hundred thirty-nine patients (85.4%) underwent laparoscopic surgery, 69 (13.4%) open surgery and 1.2% underwent conversion from laparoscopic to open surgery. In 2020 a perforation rate of 27.8% (49/176 patients) was found, in 2018–2019 perforation rate was 20.7% (70/338 patients, p = 0.0359, Cochran-Mantel-Haenszel-Test). Subgroup analysis showed that in younger patients (≤ 11.2 years), in 2020 perforation rate was significantly higher with 37.6% (32/85 patients), while 22.2% (39/176) in 2018/2019 (p = 0.014, Fisher's exact test).In boys perforation rate was significantly higher in 2020 with 35.0% (35/100 patients) compared to 21.4% in 2018–2019 (p = 0.0165, Fisher's exact test).Conclusion: During the period of curfew regulations in Bavaria the rate of perforated appendicitis in childhood increased significantly, especially in younger children and boys. Potentially this has to be attributed to delayed presentation to pediatric surgery care. Because of potential long-term sequelae of perforated appendicitis these adverse effects during curfew have to be taken into account for future political decision making to ensure reasonable patient care and avoid collateral damage in near-future or on-going pandemic situations.

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Section: Discussionmentioning

confidence: 99%

Increased Incidence of Perforated Appendicitis in Children During COVID-19 Pandemic in a Bavarian Multi-Center Study

et al. 2021

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“…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%

“…43 However, this increasing incidence of pediatric AA cases was not demonstrated in the large COVID-19 pandemic area in northern Italy. 44 Although many peripheral centers that would have normally treated children with AA frequently sent patients to one of the six specialized pediatric surgical units, the overall incidence remained unchanged compared with previous years. Similar findings have been reported by other authors who have also treated a comparable number of children with AA during the initial peak of the pandemic as in prior years without any demographic differences.…”

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

confidence: 99%

“…53 Nevertheless, not all authors found significant differences in the duration of AA symptoms before ED presentation in the pediatric population compared with the pre-COVID-19 era. 34,44,54,55 Rate of Perforated Appendicitis in Children during the Global COVID-19 Pandemic Generally, appendix perforation occurs 36 to 48 hours after onset of symptoms, and is nearly universal in children 3 years or younger, whereas its rate in adolescents is 20 to 30%. 21,[56][57][58] Therefore, a delayed presentation and access to ED could theoretically explain a higher incidence of complicated AA in pediatric patients during the global COVID-19 pandemic.…”

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

confidence: 99%

“…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. 48…”

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

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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Appendicitis in Children in a Large Italian COVID-19 Pandemic Area

Cited by 35 publications

References 8 publications

Increased Incidence of Perforated Appendicitis in Children During COVID-19 Pandemic in a Bavarian Multi-Center Study

Increased Incidence of Perforated Appendicitis in Children During COVID-19 Pandemic in a Bavarian Multi-Center 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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