Complicated appendicitis due to diagnosis delay during lockdown period in Italy

Bellini, Tommaso; Rotulo, Gioacchino Andrea; Carlucci, Marcello; Fiorenza, Venusia; Piccotti, Emanuela; Mattioli, Girolamo

doi:10.1111/apa.15756

Cited by 10 publications

(14 citation statements)

References 5 publications

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“…On the other hand the concomitant fear of acquiring SARS-CoV-2 infection during ED stay, could induce to avoid access to hospital care, even in presence of severe clinical conditions, with the risk of diagnostic delay as reported by others [1][2][3][4][5]. However, according to the triage urgency code only, we did not observe an increase of patients assessed for critical conditions (red and yellow code).…”

Section: Discussioncontrasting

confidence: 40%

“…Possible reasons for this decrease were the reduction of other seasonal infections due to self-isolation, the recommendation not to use the ED in the absence of serious conditions, and, above all, the fear of patients and parents of being infected with SARS-CoV-2. Most of the non-emergent diseases usually seen at our pediatric ED have been avoided but, one of the most negative consequences was delayed access to pediatric emergency facilities, even for the most severe non-SARS-CoV-2 related conditions [1][2][3][4][5].…”

Section: Introductionmentioning

confidence: 99%

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The impact of COVID-19 lockdown on infectious diseases epidemiology: The experience of a tertiary Italian Pediatric Emergency Department

Rotulo

Percivale

Molteni

et al. 2021

The American Journal of Emergency Medicine

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The aim of this study was to describe the rate and types of community-acquired respiratory infections observed in a pediatric ED during the SARS-CoV-2 related lockdown in Italy and to compare data with the same period of previous year. Methods: A retrospective analysis of medical charts of patients arrived at the ED of Gaslini Children's Hospital from 10th March 2020 to 30th April 2019 and the same frame of 2020 were performed. We compared two groups by demographics, duration of fever before ED admission, triage code, number of patients hospitalized after ED evaluation. We calculated proportion and incidence rate for airborne infections, fever, and urinary tract infections (UTI), appendicitis, and gastroenteritis for control. Results: 1362 children arrived at the ED during the lockdown compared to 5628 in the same period of 2019 (−75,8%). No difference was noticed (27.7% vs 28.4%) in the total amount of infectious episodes. A significant reduction in rate of incidence and proportion were observed for upper respiratory tract infections (21,4% vs 28%), otitis (2,6% vs 16,2%), streptococcal infections (0,5% vs 5,2%) and bronchiolitis (2,1% vs 5,7%). Conversely, FUO (27,8 vs 11,1%), infectious mononucleosis (2,6% vs 0,4%), UTI (7,4% vs 2,9%) and appendicitis (6,8% vs 1,1%) significantly increased. Median time from the onset of fever and arrival in ED was significantly lower in 2020 group. Conclusion:Our results demonstrated a reduction in community-acquired respiratory infections during the lockdown for COVID-19. The increase in rate of FUO and febrile conditions, together with the short time from fever onset and ED visit could be related to the fear for a SARS-CoV-2 infection.

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Section: Discussioncontrasting

confidence: 40%

Section: Introductionmentioning

confidence: 99%

The impact of COVID-19 lockdown on infectious diseases epidemiology: The experience of a tertiary Italian Pediatric Emergency Department

Rotulo

Percivale

Molteni

et al. 2021

The American Journal of Emergency Medicine

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“…This result is discordant with other Australian studies, with increased rates of complicated appendicitis reported at a major paediatric tertiary centre in Queensland during the pandemic, despite improved availability of emergency operating theatres. 6 Internationally, similar findings of increased rates of complicated appendicitis have been reported in paediatric patients in Italy, 7 and in both paediatric 8 and adult cohorts 9 in Germany where appendicitis was used in these studies as a proxy for the investigation of delayed presentation to hospital more generally. Our findings suggest there may not be a similar reluctance to seek healthcare in Victoria despite extended periods of lockdown and stay at home orders.…”

Section: Discussionsupporting

confidence: 68%

The impact of Victorian COVID‐19 lockdowns on the presentation and management of acute appendicitis

Rajagopalan

Roschach

Grant

et al. 2022

ANZ Journal of Surgery

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Backgrounds The COVID‐19 pandemic presents ongoing challenges for healthcare. Stay at Home orders (‘lockdowns’) and community fears have been suggested to create reluctance to seek healthcare. We aimed to determine whether the rates of perforated appendicitis and negative appendicectomy have been affected by the pandemic, and to analyse the effect of lockdowns on the management of acute appendicitis in Victoria. Methods We conducted a retrospective audit of emergency appendicectomies performed under adult General Surgery units at Monash Health in Victoria from January 2019 to September 2021, including 242 days of lockdown. Results 2459 patients were included. Fewer patients had perforated appendicitis during the second lockdown (6.3% versus 10.7% baseline; p = 0.027). The rate of negative appendicectomy was reduced during the first lockdown (4.1% versus 14.9% baseline; p = 0.002) and during intervals between lockdown in 2021 (9.8%; p = 0.010). There was no difference in the rate of perforated appendicitis or negative appendicectomy at other times. Time to surgery and number of appendicectomies performed were also not significantly different. Fewer appendicectomies were performed after hours during lockdowns and in 2021 more generally compared to baseline (p < 0.05). Conclusion The lower negative appendicectomy rate during the first lockdown may reflect increased pre‐operative imaging or clinical observation for undifferentiated presentations. There was a reduction in perforated appendicitis during the second lockdown, and no significant difference at other times. Contrary to other studies, lockdowns associated with the COVID‐19 pandemic may not create a reluctance to seek healthcare in all regions.

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“…9 studies examined the effect of COVID-19 on the rate of complicated appendicitis in children, covering 2065 children (1650 before and 415 during the pandemic) [ [42] , [43] , [44] , [46] , [47] , [48] , [49] , 52 , 60 ]. There was a trend seen towards more CA during the pandemic, but this effect is without statistical significance (P = 0.12).…”

Section: Resultsmentioning

confidence: 99%

Changes in appendicitis treatment during the COVID-19 pandemic – A systematic review and meta-analysis

Köhler

Müller

Hendricks

et al. 2021

International Journal of Surgery

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Background During the COVID-19 pandemic in 2020 a decrease of emergency consultations and modification in treatment of numerous medical conditions were observed. Aim of this paper was to evaluate the effect of the COVID-19 pandemic on incidence, treatment strategies, severity, length of hospital stay and time of presentation in adults and children with acute appendicitis. Methods A systematic literature search of Pubmed, Embase and Cochrane databases was performed, and eligible studies used to perform a meta-analysis. Results 46 suitable studies were identified with an overall reduction of appendicitis cases by 20.9% in adults and an increase of 13.4% in children. The rate of open appendectomies increased without statistical significance in both groups (adults: 8.5% vs. 7.1%, P = 0.32; children: 7.1% vs. 5.3%, P = 0.13), whereas the rate of antibiotic treatment increased significantly (P = 0.007; P = 0.03). Higher rates of complicated appendicitis were observed in adults (adults: OR 2.00, P < 0.0001; children: OR 1.64, P = 0.12). Time to first consultation did not change significantly (adults: 52.3 vs. 38.5 h – P = 0.057; children: 51.5 vs. 32.0 h – P = 0.062) and length of stay was also not lengthened during the pandemic (adults: 2.9 vs. 2.7 days, P = 0.057; children: 4.2 vs. 3.7 days, P = 0.062). Conclusion The COVID-19 pandemic of 2020 had major impact on incidence and treatment strategies of acute appendicitis. Results of this meta-analysis might be another hint to support the theory that appendicitis is not a progressive disease and surgeons can safely consider antibiotic therapy for acute uncomplicated appendicitis.

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Complicated appendicitis due to diagnosis delay during lockdown period in Italy

Cited by 10 publications

References 5 publications

The impact of COVID-19 lockdown on infectious diseases epidemiology: The experience of a tertiary Italian Pediatric Emergency Department

The impact of COVID-19 lockdown on infectious diseases epidemiology: The experience of a tertiary Italian Pediatric Emergency Department

The impact of Victorian COVID‐19 lockdowns on the presentation and management of acute appendicitis

Changes in appendicitis treatment during the COVID-19 pandemic – A systematic review and meta-analysis

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