Delayed diagnosis of paediatric appendicitis during the COVID‐19 pandemic

Abstract

Since it was first detected, novel coronavirus disease rapidly spread, striking over 4 million people worldwide. 1 While adults with COVID-19 demonstrate a range of disease severity with 20% of infected adults being critically ill and an estimated fatality rate as high as 2%, children mostly suffer from a mild disease, only minority presenting with respiratory distress syndrome or multi-organ failure. [2][3][4] However, the role of infected children in spreading the virus to their older relatives and caregivers is yet to be determined.Many countries struggle to stave off the spreading of COVID-19 by using different strategies. In many countries, including Israel, authorities instructed the public to stay at home and to avoid visiting local clinics and hospitals as much as possible while using more telemedicine-based practice. 5 However, emergent medical situations continue to appear alongside the current outbreak and their diagnosis should still be made promptly. Delayed diagnosis and treatment of those common paediatric conditions may lead to significant morbidity that may overweigh the harm caused by COVID-19 infection.Appendicitis is the most common abdominal surgical emergency in paediatric population. 6 Early diagnosis of appendicitis

Comparison of Acute Appendicitis Before and Within COVID 19 Era: A Retrospective Study from Rural Nepal

“…[5] Our study showed almost similar rates of perforation though there was slight increase in perforation rates in group B by six percent comparing to group A patients (14.2% vs 20 %) while total complicated cases increased by around 7 % (16.67 % vs 24 %). Snapiri et al [9] showed total complicated rates of 22 % during COVID times which was similar to study by Tankel et al [6] Overall prevalence of fecalith was 9.5 % in our study in which 16.67 % of perforations in group A and 60 % of perforations in group B were fecalith induced. The prevalence rate was somehow similar to study from West Indies by Ramdass et al [10] where fecaliths were present in 13.6% of the appendectomy specimens.…”

Increasing incidence of complicated appendicitis during COVID-19 pandemic

“…9,10 Our findings are in accordance with a recent report by Snapiri et al In their study they describe seven pediatric patients that received late diagnosis of acute appendicitis which resulted in higher rates of complications, such as perforated appendix and/or peri-appendicular abscess formation. 11 The authors recognized parental concern of contracting COVID-19 in places like the ER as a potential reason for the delayed possible explanation for the decrease in the number of acute appendicitis patients noted in our study could be the decreasing incidence of acute appendicitis in Western countries and its seasonal variation. In the United States the incidence of perforated and nonperforated acute appendicitis, as well as the number of appendectomies performed has been decreasing in recent years.…”

Decreased number of acute appendicitis cases in pediatric population during the COVID-19 pandemic: Any link?

“…Some authors have proposed that milder forms can be treated conservatively at home [15] or using antibiotics [9]. Snapiri et al also reported delays in diagnosing AA in seven pediatric patients having complicated forms of AA [16]. We believe that other factors may contribute to the decrease including various infectious agents (viruses, bacteria, fungi and parasites) whose exposure in the pediatric population and a potential link to AA have been proposed [17,18].…”