Impact of the COVID-19 pandemic on emergency department CT for suspected diverticulitis

Gibson, Averi L.; Chen, Byron Y.; Rosen, Max P.; Paez, S. Nicolas; Lo, Hao S.

doi:10.1007/s10140-020-01865-3

Cited by 18 publications

(26 citation statements)

References 21 publications

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“…Imaging ordering trends in our study were similar to those in others that reported overall decreased imaging utilization mirroring decreased patient census [ 16 , 18 ]. However, we did not find any increase in the utilization of CT to diagnose acute appendicitis during the pandemic, as was reported by Romero et al [ 19 ], whose study included adult and pediatric patients.…”

Section: Discussionsupporting

confidence: 87%

“…Imaging trends in acute appendicitis have not been as thoroughly studied. A few authors have reported decreased numbers of emergent CTs ordered out of the emergency department (ED) during the pandemic but with a higher proportion of positive findings and more advanced stages of disease [ 16 – 18 ]. A study by Romero et al [ 19 ] is the only one in the radiology literature to focus on imaging trends in acute appendicitis during the COVID-19 pandemic.…”

Section: Introductionmentioning

confidence: 99%

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Imaging pediatric acute appendicitis during the coronavirus disease 2019 (COVID-19) pandemic: collateral damage is variable

et al. 2021

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Background Since coronavirus disease 2019 (COVID-19) was declared a worldwide pandemic in March 2020, many authors have noted the collateral damage on non-COVID-19-related illnesses. These indirect effects of the pandemic have resulted in people presenting later and with more severe stages of disease, even if their diagnoses are not directly related to SARS-CoV-2, the virus that causes COVID-19. Objective We studied these indirect effects of COVID-19 on the imaging workup and outcomes for pediatric patients at our center who had acute appendicitis during the pandemic. Materials and methods We performed a retrospective review of cases in children ≤18 years who were evaluated for acute appendicitis during the same period, March 1 to May 31, in both 2019 and 2020. We compared demographic and clinical data as well as surgical and pathological findings, and we graded imaging findings according to severity. Differences in patient outcomes were assessed using the Wilcoxon rank sum test and the Pearson chi-square test. Results The total number of pediatric patients evaluated with imaging for acute appendicitis dropped by 43% between 2019 and 2020 (298 vs. 169), but the total number of children treated remained similar (59 vs. 51). There was proportionate use of US and CT in each timeframe but a higher percentage of positive imaging findings in 2020 (50/169, 29.6% vs. 56/298, 18.7% in 2019, P =0.04). There were more imaging examinations with features of complicated appendicitis among positive cases (9/51, 18% vs. 5/59, 8% in 2019, P =0.08) and more pathologically proven perforated cases during the pandemic (14/51, 27% vs. 6/59, 10% in 2019, P =0.11), although these results did not reach statistical significance. There were no changes in surgical management, vital signs, laboratory values, length of stay or complication rates. Conclusion There was a large drop in the number of pediatric patients imaged for acute appendicitis during the acute phase of the COVID-19 pandemic despite similar numbers of patients treated. The utilization trends of US vs. CT remained stable between time periods. The differences in imaging findings and perforation rates were less pronounced compared to other published studies.

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Section: Discussionsupporting

confidence: 87%

Section: Introductionmentioning

confidence: 99%

Imaging pediatric acute appendicitis during the coronavirus disease 2019 (COVID-19) pandemic: collateral damage is variable

et al. 2021

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“…A decline in the use of diagnostic imaging in the ED setting during the pandemic, particularly cross-sectional imaging, has also been documented. Studies have shown a significant decrease in the utilization of ED head CT examinations [ 13 ], abdominopelvic CT examinations [ 14 ], and overall ED imaging [ 15 ] in North American institutions during the COVID pandemic.…”

Section: Discussionmentioning

confidence: 99%

“…This decrease is less than the change in volume of ED ultrasounds performed by the radiology department, which neared a 60% decline. The relative decrease in utilization of radiology department ultrasound during the pandemic was certainly accentuated by the change in distribution of clinical presentations to the ED [28] and in practitioner decisions to defer imaging of lower acuity patients [14,29]. Another factor leading to our decreased ED imaging utilization in 2020 can be understood by the study population we serve.…”

Section: Discussionmentioning

confidence: 99%

Impact of the COVID-19 pandemic on radiology department emergency ultrasound utilization

et al. 2021

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Purpose To analyze the change in utilization of healthcare resources through a review of ultrasound examinations performed in the emergency department of an urban healthcare system in NYC during the time of peak COVID-19 outbreak. Methods This is a retrospective review analyzing ED ultrasound exams performed by the radiology department of an urban healthcare system during the 8-week time period of the peak COVID-19 outbreak in NYC, compared to a time-matched period one year prior. Data regarding the examination type and indication were obtained in addition to patient demographics and indicators of outcomes including admission, length of stay, and mortality. Results There was a 58% decrease in ED ultrasounds performed by the radiology department during the COVID-19 time period. Exams performed during the pandemic compared to the pre-pandemic period were more likely to be performed on men (28.3 vs 18.0%, p < 0.01), older patients (36 vs. 35 years, p = 0.02), and patients subsequently admitted (17.8 vs. 13.4%, p = 0.03). There was also a difference in the distribution of exam type ( p = 0.01). There was no difference in death, rate of surgery/intervention performed, or distribution of clinical indication. When correcting for gender, there was only an increase in studies leading to hospital admission in the female-only group (14.9 vs. 10.7%, p = 0.05). Conclusion COVID-19 had a drastic impact on the utilization of emergency department ultrasounds performed by the radiology department, with a decrease in total exams performed and changes in patient demographics, including a higher proportion of male patients and increases in some markers of disease severity, including rate of hospital admission.

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“…Overall, admissions for acute diverticulitis decreased by 56%, from 749 in pre-lockdown to 332 during lockdown. A higher percentage reduction (up to 67%) was observed in the largest series[ 11 , 12 , 14 , 16 , 17 ]. A 4%-8% decrease in the rate of uncomplicated diverticulitis (defined as localized diverticular inflammation without any abscess or perforation) was also noted during the lockdown phase in the three studies from United States.…”

Section: Resultsmentioning

confidence: 90%

What paradigm shifts occurred in the management of acute diverticulitis during the COVID-19 pandemic? A scoping review

Gallo¹,

Ortenzi²,

Grossi³

et al. 2021

WJCC

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BACKGROUND Acute colonic diverticulitis (ACD) is common in Western countries, with its prevalence increasing throughout the world. As a result of the coronavirus disease 2019 (COVID-19), elective surgery and in-patients’ visits have been cancelled or postponed worldwide. AIM To systematically explore the impact of the pandemic in the management of ACD. METHODS MEDLINE, Embase, Scopus, MedxRiv, and the Cochrane Library databases were searched to 22 December 2020. Studies which reported on the management of patients with ACD during the COVID-19 pandemic were eligible. For cross sectional studies, outcomes of interest included the number of hospital admission for ACD, as well as key features of disease severity (complicated or not) across two time periods (pre- and during lockdown). RESULTS A total of 69 papers were inspected, and 21 were eligible for inclusion. Ten papers were cross sectional studies from seven world countries; six were case reports; three were qualitative studies, and two review articles. A 56% overall decrease in admissions for ACD was observed during lockdown, peaking 67% in the largest series. A 4%-8% decrease in the rate of uncomplicated diverticulitis was also noted during the lockdown phase. An initial non-operative management was recommended for complicated diverticulitis, and encouraged to an out-of-hospital regimen. Despite initial concerns on the use of laparoscopy for Hinchey 3 and 4 patients to avoid aerosolized contamination, societal bodies have progressively mitigated their initial recommendations as actual risks are yet to be ascertained. CONCLUSION During the COVID-19 pandemic, fewer patients presented and were diagnosed with ACD. Such decline may have likely affected the spectrum of uncomplicated disease. Established outpatient management and follow up for selected cases may unburden healthcare resources in time of crisis.

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Impact of the COVID-19 pandemic on emergency department CT for suspected diverticulitis

Cited by 18 publications

References 21 publications

Imaging pediatric acute appendicitis during the coronavirus disease 2019 (COVID-19) pandemic: collateral damage is variable

Imaging pediatric acute appendicitis during the coronavirus disease 2019 (COVID-19) pandemic: collateral damage is variable

Impact of the COVID-19 pandemic on radiology department emergency ultrasound utilization

What paradigm shifts occurred in the management of acute diverticulitis during the COVID-19 pandemic? A scoping review

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