The impact of social distancing during the COVID-19 pandemic on rates of pediatric idiopathic intussusception

Abstract

Background The causes of idiopathic ileocolic intussusception are unknown, with infection as the most likely culprit. Recently, social distancing measures were implemented during the coronavirus disease 2019 (COVID-19) pandemic to decrease transmissible infectious diseases, creating an opportune setting to study the role of infection on the pathogenesis of intussusception on a population level. Objective To investigate the impact of social distancing on intussusception. Materials and methods We retrospectively reviewed air contrast enemas and pylorus ultrasounds performed between March 2010 and March 2021 to identify cases of ileocolic intussusception and hypertrophic pyloric stenosis (HPS), using the latter as a negative control. The study time frame was divided into two periods: pre-pandemic (March 2010–February 2020) and pandemic (April 2020–March 2021). The number of cases that occurred in these two time periods were compared using the Poisson regression model. Results Of the 407 cases of idiopathic ileocolic intussusception identified, 396 occurred in the pre-pandemic time period (mean = 39.6 per 12-month period) and 11 occurred in the 12-month pandemic time period. The mean monthly number of intussusceptions showed a decline of 72% (95% confidence interval [CI] 49–85%) between the pre-pandemic and pandemic time periods (3.3 vs. 0.9 monthly cases; P < 0.001). In contrast, the mean monthly number of HPS did not differ significantly ( P = 0.19). Conclusion Social distancing—imposed to curb the spread of infection during the COVID-19 pandemic—resulted in a significant decline in ileocolic intussusception, lending strong support to the theory that infection is the dominant cause of intussusception.

Impact of coronavirus disease 2019 on pediatric intestinal intussusception in the United States

“…Given known reductions in viral infections associated with social distancing and masking practices during the COVID-19 pandemic, we hypothesized that the incidence of intussusception decreased at a national level in 2020 compared to previous and subsequent years. Corroborating our hypothesis are single-center studies that have shown decreases in pediatric intussusceptions during 2020 [ 4 , 5 ]. From the surgical perspective, one study from Tokyo during the height of the COVID-19 pandemic also showed a decrease in emergent pediatric operations, with a statistically significant drop in operations related to intussusception [ 6 ].…”

“…With the implementation of mandated social distancing guidelines and mask mandates, the spread of most respiratory infections, including RSV and influenza, decreased in 2020 [ 1 ]. Given that idiopathic intussusception has been hypothesized to be primarily due to viral causes, specifically some of the common childhood viral illnesses such as RSV [ 3 ], as well as smaller studies suggesting this link [ 4 , 5 , 7 ], we hypothesized that a documented decrease in viral infections in 2020 would be associated with a decrease in intussusception at a national level. Our results support this hypothesis with more than 700 fewer diagnoses of intussusception in 2020, the period of maximal implementation of masking and social distancing.…”

How Does the COVID-19 Pandemic Affect Pediatric Patients with Intussusception Treated by Ultrasound-Guided Hydrostatic Enema Reduction?

“…Some later studies also documented that the COVID-19 pandemic and the implementations of preventative measures to combat this communicable disease have notably influenced the epidemiology of intussusception [ 15 , 16 , 17 , 18 ]. Meanwhile, Handa et al demonstrated that social distancing has resulted in a significant decline in intussusception [ 18 ].…”

“…Some later studies also documented that the COVID-19 pandemic and the implementations of preventative measures to combat this communicable disease have notably influenced the epidemiology of intussusception [ 15 , 16 , 17 , 18 ]. Meanwhile, Handa et al demonstrated that social distancing has resulted in a significant decline in intussusception [ 18 ]. Our study also noted the epidemiological feature of intussusception during the COVID-19 pandemic, in which the number of patients receiving USGHER in 2020 decreased significantly from that in 2019 ( p = 0.042).…”

“…The pandemic of COVID-19 has significantly changed the epidemiology of intussusception. Zheng et al in China were the first to report that the number of pediatric patients with intussusception decreased significantly in 2020 [ 14 ], as demonstrated by some recent studies [ 15 , 16 , 17 , 18 ]. Nevertheless, the in-depth influence of the COVID-19 pandemic on the diagnosis and treatment of intussusception for pediatric patients has not been well documented.…”