Complicated Acute Appendicitis during COVID-19 Pandemic: The Hidden Epidemic in Children

Abstract

Introduction Since home confinement for novel coronavirus disease 2019 (COVID-19) pandemic began, pediatric visits to the emergency department (ED) have decreased, including consultation for abdominal pain. Our aim is to investigate the incidence of complicated acute appendicitis (AA; peritonitis or appendicular mass) during confinement for COVID-19 pandemic and to compare it with the previous 5 years. Materials and Methods A retrospective study was performed in children with AA who underwent surgery between March 9 and April 13 from 2015 to 2020; patients were divided into six groups according to the year of surgery. We analyzed demographic variables, time from onset of symptoms, mean hospital stay, cumulative incidence, and incidence rate of complicated appendicitis. Results A total of 168 patients were included with no differences in the number of patients, gender, and age between groups. Patients in 2020 (COVID-19 group) presented longer symptom progression time (46.8 hours; p = 0.046), higher rate of complicated appendicitis (48.4%; p = 0.004), longer mean hospital stay (4.9 days; p < 0.001), increased cumulative incidence (8.27 cases per 100,000 children per 0.1 years; p < 0.001), and increased incidence rate of complicated appendicitis (83 cases per 100,000 children; p < 0.001) when compared with other groups. Conclusion Delayed ED visit of children with AA during home confinement lead to an increased rate of complicated appendicitis. It is crucial to make parents aware of the importance of early diagnosis and treatment of abdominal pain.

COVID-19 and Pediatric Gastroenterology

“…Concerns about delays in diagnosis were realized in reports of severe illness and deaths due to diabetic ketoacidosis, pyloric stenosis, sepsis and cancer in children presenting to the hospital after delays attributed to fear of COVID-19 and reduced access to care 55 , 56 . Delays in presentation were suspected to contribute to an increase the rate of complicated appendicitis in more than one series 56 , 57 , 58 , 59 . A study of a large sample of emergency departments in the US revealed a drop in pediatric visits by up to 72% compared to the same week one year prior 60 .…”

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

“…46 As a result, many centers reported during the first wave of the COVID-19 pandemic a statistical significant increase in perforated AA in pediatric patients relative to previous years, ranging between 32 and 60.5%. 32,45,52,54,60,61 Interestingly, there have been no obvious changes in patient demographics during this time to explain this increase. However, some children with AA were seen more promptly in the ED and appendectomies were frequently performed sooner due to the reduction in elective surgeries.…”

Letter to the Editor: Delayed Presentation of Non-COVID-19 Patients During the COVID-19 Pandemic Is Not Limited to Children

“…However, in our view there is nothing specifically pediatric in his observations. Several recent papers discuss delays of diagnosis and treatment of non-COVID-19 diseases during the pandemic, including head and neck cancer, 2 appendicitis, 3 , 4 heart failure and septicemia, 5 pulmonary thromboembolism, 6 pyelonephritis, 7 and cancer in general. 8 Some patients in these papers are administratively still “children,” 1 , 3 , 7 some are adults, and appendicitis is discussed in both.…”

“…Several recent papers discuss delays of diagnosis and treatment of non-COVID-19 diseases during the pandemic, including head and neck cancer, 2 appendicitis, 3 , 4 heart failure and septicemia, 5 pulmonary thromboembolism, 6 pyelonephritis, 7 and cancer in general. 8 Some patients in these papers are administratively still “children,” 1 , 3 , 7 some are adults, and appendicitis is discussed in both. 3 , 4 The delay the COVID-19 pandemic has caused in the timely diagnosis of various diseases is not a “pediatric” challenge, but a challenge for medicine in general.…”

“… 8 Some patients in these papers are administratively still “children,” 1 , 3 , 7 some are adults, and appendicitis is discussed in both. 3 , 4 The delay the COVID-19 pandemic has caused in the timely diagnosis of various diseases is not a “pediatric” challenge, but a challenge for medicine in general.…”