Paediatric Appendicitis Management During the COVID-19 Pandemic: What Has Changed?

Abstract

The most common surgical emergency in the paediatric group during the coronavirus disease-2019 (COVID-19) pandemic is appendicitis, as it was before. This study aimed to evaluate clinical differences of paediatric appendicitis cases and changes in the management strategy between the pandemic and non-pandemic period.Methods: Cases during the non-pandemic period (March-July 2019) and pandemic period (March-July 2020) were analysed. Demographic data, duration of symptoms, physical examination, laboratory and radiological findings, paediatric appendicitis score (PAS), operative techniques, medical treatment, complications and hospital stay were evaluated retrospectively.Results: This study enrolled 70 patients during the non-pandemic period and 48 patients during the pandemic period. Duration of symptoms was significantly prolonged (p<0.001) and PAS was significantly increased during the pandemic period (p=0.001). Abdominopelvic ultrasonography detected abscess formation in one (1.4%) patient and 10 (20.8%) patients during the non-pandemic period and pandemic period, respectively. Complicated appendicitis was significantly higher (p=0.025) and the hospital stay were significantly longer during the pandemic period (p=0.017). Conclusion:During the COVID-19 pandemic, fewer patients presented to the paediatric emergency department with suspected appendicitis. Complicated appendicitis cases and hospital stay increased during the same period. The COVID-19 pandemic caused some changes in our approach to paediatric appendicitis cases such as the effective use of personal protective equipment, PAS scoring system and abdominopelvic ultrasonography.

Comparison of the 'Patient Management and Outcomes' of the Pediatric Patient Groups Who Had Appendectomy During the COVID-19 Pandemic Period and the Pre-Pandemic Period in Terms of the Efficiency of the Management Plan: Cross-Sectional Research

“…While the laparoscopic appendectomy method was preferred for appendicitis in the pre-pandemic period, During the pandemic period, open appendectomy was preferred in cases of complicated appendicitis with an appendiceal mass that cannot be separated by external manipulation, generalized peritonitis with massive abdominal distension, and COVID-19 PCR positivity. 12 At the beginning of the pandemic period, the idea that laparoscopic surgery increased contact with patient secretions and that the duration of the operation, increased the risk of COVID-19 transmission, was suggested and this idea was effective in this approach. Laparoscopic surgery has been the preferred treatment method for patients diagnosed with appendicitis during the pandemic period in our clinic.…”

“…In this period, it has been reported that there is an increase in the rate of compli-cated appendicitis in patients with appendicitis due to the delays in going to the emergency department and the time elapsed while waiting for the pre-operative COVID-19 PCR result. 12 However, due to the similarity of symptoms, it has been reported that there is an increase in the rates of patients with the operation and negative appendectomy with the wrong diagnosis of appendicitis.…”

“…Considering the difference between the two periods, it can be deduced that lockdowns and fear of contagion caused a decrease in hospital admissions, as also reported in the literature. 12…”