Impact of the COVID-19 pandemic on the pediatric population with acute appendicitis: Experience at a general, tertiary care hospital

Abstract

Introduction. Appendicitis is the leading cause of surgical acute abdomen in pediatrics. During the COVID-19 pandemic, management strategies were reassessed and the number of visits to the emergency department dropped down, which may be associated with delayed diagnoses and complications. The objective of this study was to analyze the impact of the pandemic on children with acute appendicitis. Methods. Analytical, retrospective, comparative study of pediatric patients with acute appendicitis in the 5 months of COVID-19 lockdown versus the same period in the previous year. Incidence, clinical data, stage, surgical approach, and complications were analyzed. Results. The total number of appendicitis cases went down by 25 % (n = 67 versus n = 50 in 2020). The mean time to consultation was 24 hours in both periods (p = 0.989). The incidence of peritonitis was 44 % (n = 22) versus 37 % (n = 22) (p = 0.22) in 2019. No differences were observed in terms of appendicitis stage based on surgery reports. In 2019, all surgeries were laparoscopic; while in 2020, only 42 % (n = 21). The incidence of complications was 6 % versus 7.5 % in the previous period (p = 0.75). One patient was COVID-19 positive. Conclusion.Although in our population the number of appendicitis cases dropped down, consultation was not delayed. The greater impact was associated with the reformulation of management strategies, in which the laparoscopic approach is avoided to reduce virus transmission.

Changes in Access to Health Services during the COVID-19 Pandemic: A Scoping Review

“…1 : General health services include different levels of care or type of service; 2 : aggregated data and/or no specification of the different periods of analysis; 3 : studies that did not analyze whether the changes were statistically significant (the rest of articles presented results statistically significant); AF: associated factors; ED: emergency department; ICU: intensive care unit; IRR: incidence rate ratio; OB-GYN: obstetrics-gynecology; OR: odds ratio; PC: primary care; RR: relative risk; SC: secondary care; SRH: sexual and reproductive health. With regard to the type of service, of the studies on realized access, 5 focused on health services in general [46][47][48][49][50]; 12 on emergencies [51][52][53][54][55][56][57][58][59][60][61][62] (of which 5 were related to pediatric emergencies [56][57][58]60,61]); 15 on secondary care (SC) (outpatient visits, hospital admissions, etc., for nephrology [63], oncology [64,65], pediatrics [66], psychiatry [67,68], rehabilitation [69], respiratory diseases [70], sexual and reproductive health (SRH) [71,[73][74][75], and traumatology [78,79]); two on primary care (PC) [80,81]; one on preventive services…”

“…In terms of geographical area, 19 studies were conducted in European countries [47,51,53,55,57,62,64,[67][68][69][70]75,79,83,84,88,90,92,95], 9 in North American countries [49,58,59,77,78,80,82,85,86], 9 in Sub-Saharan Africa [46,48,71,72,76,87,93,94,98], 3 in Latin America [60,91,96], 5 in the East Asia-Pacific region [50,56,61,66,81], 3 in South Asia [63,65,74], 2 in the North Africa-Middle East region [52], and, lastly, 3 studies covered various regions…”

“…With regard to the period of analysis, 38 of the selected studies were conducted over the first months of the pandemic (February to June 2020) [46][47][48][49][50][51][52][53][54][55][57][58][59][60]62,[65][66][67][68][69][70][72][73][74][75][76][77][78][79][80]82,84,86,88,90,92,93,98]; 4 during the second stage of the pandemic (June to September 2020) [85,89,91,96]; 1 at a later stage (September to November 2020) [94]; finally, 8 analyzed the whole period (February to December 2020) [56,61,63,64,71,…”

“…No studies were found that analyzed periods after December 2020. All studies that analyzed realized access presented their results in comparison with a previous period: 32 of the first-stage studies compared the changes to pre-pandemic periods of reference [46][47][48][49][50][51][52][53][54][55][57][58][59][60]62,[65][66][67][68][69][70][72][73][74][75][76][77][78][79][80]82,98], as did 6 of those that analyzed the whole period [56,61,63,64,71,83]. One study did not specify the exact period of 2020 analyzed [95].…”

Impact of the COVID-19 Pandemic on Emergency Care Utilization and Outcomes in Pediatric Patients with Intussusception

“…Failure to access life-saving treatments can increase the severity of the disease, causing complications and even death [ 6 ]. During the COVID-19 pandemic, changes in the diagnosis and treatment results for abdominal pain requiring surgery, such as acute appendicitis, and even changes in treatment trends, have been actively reported [ 7 , 8 , 9 , 10 , 11 , 12 ]. On the other hand, there have been few reports of intussusceptions in pediatric patients.…”