Comparative Analysis of the Acute Appendicitis Management in Children before and During the Coronavirus Disease-19 Pandemic

Year 2023, Volume: 18 Issue: 1, 120 - 125, 16.03.2023

Dilan Altıntaş Ural Ali Erdal Karakaya Ahmet Gökhan Güler Hatice Sonay Yalçın Mustafa Tuşat

https://doi.org/10.17517/ksutfd.1089646

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

appendicitis, COVID – 19, complicated appendicitis.

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,

Koronavirüs-19 Pandemisi Öncesi ve Sırasında Çocuklarda Akut Apandisit Yönetiminin Karşılaştırmalı Analizi

Abstract

Amaç: Koronavirüs-19 (COVID-19) salgınında pek çok hastalığın tanı ve tedavisinde gecikme olmuştur. Bu çalışmanın amacı COVID-19 salgını öncesinde ve sırasında akut apandisit (AA) insidansını ve şiddetini karşılaştırmaktır. COVID-19 salgınının apandisit hasta sayısı ve komplikasyonları üzerindeki etkisini araştırmaktır.
Gereç ve Yöntemler: Bu çok merkezli çalışma üç tıp fakültesi hastanesinde 15 Mart-30 Haziran 2019 tarihi ile pandemi dönemi olan 15 Mart–30 Haziran 2020 tarihleri arasında retrospektif olarak yapıldı. İki grup oluşturuldu. Grup A, 2019 yılında acile karın ağrısı nedeniyle başvuran 1655 hastadan (64 hasta AA tanılı) oluşurken, Grup B pandemi döneminde karın ağrısı ile acile başvuran 1120 hastadan (77 hasta AA tanılı) oluşmaktadır. Her gruptaki hastaların klinikopatolojik özellikleri arasında karşılaştırma yapıldı.
Bulgular: Acil servise karın ağrısı nedeniyle başvuran hastalar, akut ve komplike apandisit olarak değerlendirildi. Grup A’de toplam karın ağrısı ile başvuran 1655 hastanın 64’ü(%3.86) apandisit tanısı alırken, Grup B’de 1120 hastanın 77’si (%6.87) apandisit olmak üzere toplam 141 hastaya apandisit teşhisi konuldu. Grup A 64 apandisit hastasının 52’si (%81) akut apandisit, 12’si (%18.75) komplike apandisit, Grup B ‘de 77 hastanın 47’si (%61) akut apandisit, 30’u (%38.9) komplike apandisit olarak değerlendirildi.
Sonuç: Akut pandemik dönemde karantina dışı döneme göre daha az hasta başvurdu ama yüksek oranda apandisit tanısı konmuştur. COVID‐19 döneminde, daha fazla apandisit hastası hastalığın geç evresinde başvurmuştur. Vakalarımızda pandemi döneminde komplike apandisit oranının yüksek olmasının, COVİD-19 salgını nedeniyle gecikmiş tanı sebebiyle olduğuna inanıyoruz.

Keywords

apandisit, covid-19, komplike apandisit

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.
• Rothrock SG, Pagane J. Acute appendicitis in children: emergency department diagnosis and management. Ann Emerg Med. 2000;36(1):39-51.
• Rothrock SG, Skeoch G, Rush JJ, Johnson NE. Clinical features of misdiagnosed appendicitis in children. Ann Emerg Med. 1991;20(1):45-50.
• Pepper VK, Stanfill AB, Pearl RH. Diagnosis and management of pediatric appendicitis, intussusception, and Meckel diverticulum. Surg Clin North Am. 2012;92(3):505-526.
• St Peter SD, Sharp SW, Holcomb GW 3rd, Ostlie DJ. An evidence-based definition for perforated appendicitis derived from a prospective randomized trial. J Pediatr Surg. S. Arslan B, Aydoğdu MS, Arslan H, Zeytun M, Okur E, Basuguy et al. Analysis of risk factors for appendicitis in children: A multicenter epidemiological study. Dicle Medical Journal. 2016;43(4):556-560.
• Mandeville K, Monuteaux M, Pottker T, Bulloch B. Effects of timing to diagnosis and appendectomy in pediatric appendicitis. Pediatr Emerg Care. 2015;31(11):753-758.
• Spinelli A, Pellino G. COVID-19 pandemic: perspectives on an unfolding crisis. Br J Surg. 2020;107(7):785-787.