Comparative Analysis of the Acute Appendicitis Management in Children before and During the Coronavirus Disease-19 Pandemic
Abstract
Objective: Acute appendicitis (AA) is one of the most common surgical emergency in pediatric population. Herein, we aimed to compare the incidence and severity of AA before and during the Coronavirus Disease-19 (COVID-19) outbreak.
Materials and Methods: This multicenter study was conducted in three medicine faculty hospitals between the periods of 15 March-30 June 2019 (Group A), and the pandemic period of 15 March-30 June 2020 (Group B). We evaluated the clinicopathological characteristics of the patients in each group in terms of age, gender, serum leukocyte, C-reactive protein, radiological imaging use of postoperative peritoneal drain and presence of serious complications.
Results: A total of 141 patients were identified and divided into two groups as Group A (n=64) and Group B (n=77). We found higher complication rates in Group B. Fewer patients applied in Group B, but a higher rate of AA was diagnosed. During the COVID-19 period, more patients were admitted with the later stages of the AA and with significant complications. Radiological imaging of patients with appendicitis in Group B showed more severe findings compared to Group A.
Conclusion: Higher rate of perforated and complicated appendicitis in the pandemic period was due to misdiagnosis/delayed diagnosis in primary care centers as a result of fear from contagious coronavirus. Although the period of the COVID -19 pandemic brings out difficulties in treatment of patients, comprehensive assessment and physical examination in children with suspected surgical conditions should always be emphasized.
Keywords
Thanks
Dear Editor-in-Chief,
Please find enclosed our manuscript, “Evaluation of Appendicitis Cases Amid COVID -19 Pandemic ’’ by Dilan Altıntaş Ural et al. which we would like to submit for publication as an original article in Kahramanmaraş Sütçü İmam University Faculty of Medicine Journal.
Herein, we describe our scientific observations and evaluation on acute appendicitis,the most widespread acute abdomen pathology of children, during the ongoing Covid-19 pandemic. We believe this study is interesting to a global audience since it will make contributions to literature and serve well especially to paediatricians and paediatric surgeons. Thus with this features, we hope this article will be found suitable to be published in this precious journal.
All of the authors declare that they have all participated in the design, execution, and analysis of the paper, and that they have approved the final version. Additionally, there are no conflicts of interest in connection with this paper and the material described is not under publication or consideration for publication elsewhere.
Thank you for your valuable time.
Yours sincerely,
References
- Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: Summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention. JAMA. 2020;323(13):1239-4122.
- Cervellin G, Mora R, Ticinesi A, Meschi T, Comelli I, Catena F et al. Epidemiology and outcomes of acute abdominal pain in a large urban emergency department: Retrospective analysis of 5340 cases. Ann Transl Med. 2016;4(19):362.
- Addiss DG, Shaffer N, Fowler BS, Tauxe RV. The epidemiology of appendicitis and appendectomy in the United States. Am J Epidemiol. 1990 Nov;132(5):910-925.
- Johnston MJ, Fitzgerald JE, Bhangu A, Greaves NS, Prew CL, Fraser I. Outpatient management of biliary colic: A prospective observational study of prescribing habits and analgesia effectiveness. Int J Surg. 2014;12(2):169-176.
- Humes DJ. Diagnosing and managing acute diverticulitis. Practitioner. 2012;256(1753):21-23.
- Sivit CJ, Siegel MJ, Applegate KE, Newman KD. When appendicitis is suspected in children. radiographics. 2001 Jan-Feb;21(1):247-62; questionnaire 288-94.
- Ferris M, Quan S, Kaplan BS, Molodecky N, Ball CG, Chernoff GW et al. The global incidence of appendicitis: A systematic review of population-based studies. Ann Surg. 2017;266(2):237-241.
- Scholer SJ, Pituch K, Orr DP, Dittus RS. Clinical outcomes of children with acute abdominal pain. Pediatrics. 1996;98(4 Pt 1):680-685.
- Hall NJ, Eaton S. Non-operative management of appendicitis in children. Arch Dis Child. 2018;103(5):498-502.
- Minneci PC, Mahida JB, Lodwick DL, Sulkowski JP, Nacion KM, Cooper JN et al Effectiveness of patient choice in nonoperative vs surgical management of pediatric uncomplicated acute appendicitis. JAMA Surg. 2016;151(5):408-415.