Impact of COVID-19 on the presentation and course of acute appendicitis in paediatrics

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

“…During this first wave of the COVID-19 pandemic in spring 2020, several authors noticed an obvious decrease in pediatric emergency department (ED) visits compared with previous years, ranging between 55 and 87%. [31][32][33][34] Simultaneously, a marked reduction in the number of pediatric outpatient visits and elective surgeries was observed. 35 A similar shift in ED admission patterns was seen during previous outbreaks of influenza and Middle East Respiratory Syndrome.…”

“…47 This similarly applied to the rate of postoperative complications (e.g., intraabdominal abscess), ED visits, and 30-day readmissions. 34,43,46,55 In contrast, pediatric patients treated for AA at a large children's hospital in New York during the first peak of the COVID-19 pandemic had a significantly longer LOS by a median of 1 day and also a significantly longer duration until symptom resolution by a median of 1 day compared with those who presented during the same time period in 2019. 51 It has been indicated that deferring surgical management for AA in children who were SARS-CoV-2 positive may have resulted in longer LOS, and required prolonged antibiotic therapy and multiple interventional radiology-guided procedures for infectious control management.…”

“…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…”

“…46 Others have noticed an additional delay from arrival at the ED until surgery by 3.5 hours, resulting in an increase in histologically evolved AA in children. 34 Furthermore, pediatric patients with AA often spent a significantly longer time in the ED due to the response time for SARS-CoV-2 nasopharyngeal swabs. 46 A decreased access to outpatient care and increased need for transfer between health-care centers most likely also contributed to delayed presentation and treatment of children with AA.…”

“…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.…”