Statewide Impact of the COVID Pandemic on Pediatric Appendicitis in California: A Multicenter Study

Theodorou, Christina M.; Beres, Alana L.; Nguyen, Michelle; Castle, Shannon L.; Faltermeier, Claire; Shekherdimian, Shant; Tung, Christine; DeUgarte, Daniel A.; Brown, Erin G.

doi:10.1016/j.jss.2021.05.023

Cited by 19 publications

(32 citation statements)

References 14 publications

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“…For this outcome, the estimated heterogeneity among the included studies was statistically significant (I 2 = 57%, p = 0.005). This outcome was reported by all thirteen studies [30][31][32][33][34][35][36][37][38][39][40][41][42]. A total of 980 out of 2782 children, 523 and 457 belonging to groups A and B, respectively, developed complicated appendicitis.…”

Section: Methodological Quality Assessmentmentioning

confidence: 81%

“…The studies by Place et al [33] and Theodorou et al [42] had the lowest and the highest scores, respectively. The inter-observer agreement was almost perfect (Kappa = 0.961; p < 0.001) This outcome was reported by all thirteen studies [30][31][32][33][34][35][36][37][38][39][40][41][42]. A total of 980 out of 2782 children, 523 and 457 belonging to groups A and B, respectively, developed complicated appendicitis.…”

Section: Methodological Quality Assessmentmentioning

confidence: 90%

“…Thirteen of these were further excluded as they included only adult patients ( n = 10), were letters to the editor ( n = 2), or brief communication ( n = 1). Although eighteen studies [ 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 ] were included for systematic review, only thirteen [ 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 ] were selected for the final meta-analysis. The remaining five studies [ 43 , 44 , 45 , 46 , 47 ] compared the two patient groups from non-identical time periods.…”

Section: Resultsmentioning

confidence: 99%

“…A significant differenc was observed in the four studies only [31,35,37,41]. Similarly, ten studies compared th average LOS among both groups [35,37,42]. The baseline characteristics of the studies included in the meta-analysis are demonstrated in Table 1.…”

Section: Study Characteristicsmentioning

confidence: 99%

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Incidence of Complicated Appendicitis during the COVID-19 Pandemic versus the Pre-Pandemic Period: A Systematic Review and Meta-Analysis of 2782 Pediatric Appendectomies

et al. 2022

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Background: The Coronavirus Disease 2019 (COVID-19) pandemic has impacted volume, management strategies and patient outcomes of acute appendicitis. The aim of this systematic review and meta-analysis was to evaluate whether the COVID-19 pandemic resulted in higher incidence of complicated appendicitis in children presenting with acute appendicitis compared to the pre-COVID-19 period. The secondary aim was to investigate the proportion of the patients treated by non-operative management (NOM). Methods: A systematic search of four scientific databases was performed. The search terms used were (coronavirus OR SARS-CoV-2 OR COVID-19 OR novel coronavirus) AND (appendicitis). The inclusion criteria were all patients aged <18 years and diagnosed with acute appendicitis during the COVID-19 and pre-COVID-19 periods. The proportion of children presenting with complicated appendicitis and the proportion of children managed by NOM was compared between the two groups. The Downs and Black scale was used for methodological quality assessment. Results: The present meta-analysis included thirteen studies (twelve retrospective studies and one cross-sectional study). A total of 2782 patients (1239 during the COVID-19 period) were included. A significantly higher incidence of complicated appendicitis (RR = 1.63, 95% CI 1.33–2.01, p < 0.00001) and a significantly higher proportion of children managed via the NOM (RR = 1.95, 95% CI 1.45–2.61, p < 0.00001) was observed in patients during the COVID-19 pandemic when compared to the pre-COVID-19 period. Conclusion: There is a significantly higher incidence of complicated appendicitis in children during the COVID-19 pandemic than in the pre-COVID-19 period. Additionally, a significantly higher proportion of children was managed via the NOM during the pandemic in comparison to the pre-pandemic period.

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Section: Methodological Quality Assessmentmentioning

confidence: 81%

Section: Methodological Quality Assessmentmentioning

confidence: 90%

Section: Resultsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

See 2 more Smart Citations

Incidence of Complicated Appendicitis during the COVID-19 Pandemic versus the Pre-Pandemic Period: A Systematic Review and Meta-Analysis of 2782 Pediatric Appendectomies

et al. 2022

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“…However, in some instances, the data has been variable. For example, in pediatric appendicitis, several studies have reported increased rates of perforation at presentation [3][4][5] , while a multicenter study found no changes in presentation during the COVID-19 pandemic 6 .…”

Section: Introductionmentioning

confidence: 99%

Child Abuse and the COVID-19 Pandemic

Theodorou

Brown

Jackson

et al. 2022

Journal of Surgical Research

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Spontaneous Resolution of Uncomplicated Appendicitis may Explain Increase in Proportion of Complicated Appendicitis During Covid‐19 Pandemic: a Systematic Review and Meta‐analysis

2023

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Background Reports of an increased proportion of complicated appendicitis during the Covid-19 pandemic suggest a worse outcome due to delay secondary to the restrained access to health care, but may be explained by a concomitant decrease in uncomplicated appendicitis. We analyze the impact of the pandemic on the incidences of complicated and uncomplicated appendicitis. Method We did a systematic literature search in the PubMed, Embase and Web Of Science databases on December 21, 2022 with the search terms (appendicitis OR appendectomy) AND (“COVID” OR SARS-Cov2 OR “coronavirus”). Studies reporting the number of complicated and uncomplicated appendicitis during identical calendar periods in 2020 and the pre-pandemic year(s) were included. Reports with indications suggesting a change in how the patients were diagnosed and managed between the two periods were excluded. No protocol was prepared in advance. We did random effects meta-analysis of the change in proportion of complicated appendicitis, expressed as the risk ratio (RR), and of the change in number of patients with complicated and uncomplicated appendicitis during the pandemic compared with pre-pandemic periods, expressed as the incidence ratio (IR). We did separate analyses for studies based on single- and multi-center and regional data, age-categories and prehospital delay. Results The meta-analysis of 100,059 patients in 63 reports from 25 countries shows an increase in the proportion of complicated appendicitis during the pandemic period (RR 1.39, 95% confidence interval (95% CI 1.25, 1.53). This was mainly explained by a decreased incidence of uncomplicated appendicitis (incidence ratio (IR) 0.66, 95% CI 0.59, 0.73). No increase in complicated appendicitis was seen in multi-center and regional reports combined (IR 0.98, 95% CI 0.90, 1.07). Conclusion The increased proportion of complicated appendicitis during Covid-19 is explained by a decrease in the incidence of uncomplicated appendicitis, whereas the incidence of complicated appendicitis remained stable. This result is more evident in the multi-center and regional based reports. This suggests an increase in spontaneously resolving appendicitis due to the restrained access to health care. This has important principal implications for the management of patients with suspected appendicitis.

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Statewide Impact of the COVID Pandemic on Pediatric Appendicitis in California: A Multicenter Study

Cited by 19 publications

References 14 publications

Incidence of Complicated Appendicitis during the COVID-19 Pandemic versus the Pre-Pandemic Period: A Systematic Review and Meta-Analysis of 2782 Pediatric Appendectomies

Incidence of Complicated Appendicitis during the COVID-19 Pandemic versus the Pre-Pandemic Period: A Systematic Review and Meta-Analysis of 2782 Pediatric Appendectomies

Child Abuse and the COVID-19 Pandemic

Spontaneous Resolution of Uncomplicated Appendicitis may Explain Increase in Proportion of Complicated Appendicitis During Covid‐19 Pandemic: a Systematic Review and Meta‐analysis

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