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

Abstract

The fast-evolving nature of the coronavirus disease 2019 (COVID-19) pandemic has led to unprecedented clinical, logistical, and socioeconomical challenges for health-care systems worldwide. While several studies have analyzed the impact on the presentation and management of acute appendicitis (AA) in the adult population, there is a relative paucity of similar research in pediatric patients with AA. To date, there is some evidence that the incidence of simple AA in children may have decreased during the first lockdown period in spring 2020, whereas the number of complicated AA cases remained unchanged or increased slightly. Despite a worrying trend toward delayed presentation, most pediatric patients with AA were treated expediently during this time with comparable outcomes to previous years. Hospitals must consider their individual capacity and medical resources when choosing between operative and non-operative management of children with AA. Testing for severe acute respiratory syndrome coronavirus type 2 is imperative in all pediatric patients presenting with fever and acute abdominal pain with diarrhea or vomiting, to differentiate between multisystem inflammatory syndrome and AA, thus avoiding unnecessary surgery. During the further extension of the COVID-19 crisis, parents should be encouraged to seek medical care with their children early in order that the appropriate treatment for AA can be undertaken in a timely fashion.

Impact of the Coronavirus (COVID-19) Pandemic on the Care of Pediatric Acute Appendicitis

“…Most patients in both groups had ultrasound imaging, but less than half of both groups had CT imaging. The COVID group did demonstrate a significantly delayed presentation regarding the time from SO to ED (36 hours vs 24 [12][13][14][15][16][17][18][19][20][21][22][23][24] hours, P-value = .049). The PAS was also significantly higher in the COVID group (8 [7.5-9] vs 6 [5][6][7], P-value = .003).…”

“…These findings align with several studies demonstrating no worse postoperative complications for pediatric acute appendicitis during the COVID-19 pandemic. 12,14 However, one other pediatric study identified worse outcomes. 13 This variance in findings requires that further validation be implemented to better understand and improve the clinical outcomes moving forward.…”

Impact of the COVID-19 Pandemic on Emergency Care Utilization and Outcomes in Pediatric Patients with Intussusception

“…Failure to access life-saving treatments can increase the severity of the disease, causing complications and even death [ 6 ]. During the COVID-19 pandemic, changes in the diagnosis and treatment results for abdominal pain requiring surgery, such as acute appendicitis, and even changes in treatment trends, have been actively reported [ 7 , 8 , 9 , 10 , 11 , 12 ]. On the other hand, there have been few reports of intussusceptions in pediatric patients.…”

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

“…Since the outbreak of COVID-19, this epidemic has brought about widespread restrictions on socializing, travel, business, education, and healthcare. The compulsory strategies to prevent the spread of COVID-19 by both countries and hospitals, as well as the fear of exposure and risk of infection for patients themselves [ 4 ], has changed the epidemiology of various diseases, such as bronchiolitis and asthma [ 5 ], seasonal influenza [ 6 ], acute appendicitis [ 7 ], etc. As for intussusception for pediatric patients, Zheng et al in China were the first to report that the COVID-19 pandemic and its resultant quarantine strategies have significantly reduced the incidence of intussusception [ 14 ].…”

“…In order to prevent further spread of this epidemic, many countries have carried out a series of compulsory strategies, such as wearing face masks and checking temperatures in public, cancelling large gatherings, mass testing for SARS-CoV-2, closing schools and public places, and implementing social and physical distancing and even lockdowns. Together with the fear of exposure and risk of infection for patients themselves [ 4 ], these preventative measures have resulted in a global decline, owing to the number of emergency department (ED) visits and hospitalizations of many diseases [ 5 , 6 , 7 ].…”