Unanticipated consequences of COVID-19 pandemic policies on pediatric acute appendicitis surgery

Reasons for Delayed Diagnosis of Pediatric Acute Appendicitis during the COVID-19 Era: A Narrative Review

“…Governments responded by implementing a series of lockdowns or stay-at-home orders and enforced travel restrictions between areas, cities, regions and countries. The stringency of social distancing or isolation varied across nations as referenced by numerous studies [20,27,53]. Stricter policies could, however, amplify fear and uncertainty, thus delaying presentation to the hospital as was potentially the case for New Zealand vs. Australia [20].…”

“…Travel restrictions between cities, provinces and regions and the assignment of pediatric hospitals or wards to adult COVID-19 care could have delayed pediatric appendicitis diagnosis by lengthening the times to examination by a surgeon and admission to a hospital [27]. Studies focusing on rural area populations have illustrated such delays during pre-pandemic periods [57].…”

Incidence and severity of pediatric appendicitis during the COVID‑19 pandemic

“…However, we caution the authors, as they draw conclusions about all of Canada, but both institutions involved in this study are located in Montreal. We conducted a similar study evaluating pediatric appendicitis at our institution in Toronto, Ontario, and found different results, as compared in Table 1 [ 2 ]. We similarly found significant increases in acute appendicitis incidence and no significant difference in length of stay; however, our results suggest worsened outcomes during the pandemic, demonstrated through an increased rate of complicated/perforated appendicitis (from 28.3% to 38.8%).…”

Response to “Incidence and severity of pediatric appendicitis during the COVID‑19 pandemic”

“…We would like to thank Quaglietta et al [1] for their interest in our study and making their data available to allow comparison with our article [2] on the impact of the coronavirus disease 2019 (COVID-19) pandemic on pediatric appendicitis.…”

“…We agree with the authors that our article could not reflect the experience of all hospitals and provinces in Canada. The comparison of both articles [1,2] highlights the fact that multiple factors can impact the risk of complications among children with appendicitis. Beyond common national policies, different provincial and local influences may affect health outcomes.…”