Is the COVID-19 Pandemic Causing Delays in the Diagnosis of Appendicitis in Children?

Abstract

Objective: We aimed to investigate whether there is an increase in the number of complicated appendicitis during pandemic period.

Material and Methods: Data of patients were evaluated retrospectively. Patients were divided into two-groups as pre-pandemic and pandemic. Age, gender, duration after the onset of complaints until visiting hospital, WBC count, days after presentation to hospital until surgery, surgical method, whether the appendix was complicated, duration of hospitalization, whether any complications developed, and results of PCR tests were evaluated. The data of the groups were compared and it was investigated whether there was any difference between them. Statistical analysis was done with the SPSS (Statistical Package for Social Sciences) version 21. P < 0.05 was considered significant.

Results: Appendectomy was performed in 327 patients during pandemic and in 295 during pre-pandemic period. Although the ratio of complicated appendicitis increased during pandemic compared to pre-pandemic period (47.1% versus 40.7%), there was no difference between groups. However, duration between onset of symptoms and arrival at hospital (p=0.003), time elapsed before surgery (p=0.021), length-of-stay in hospital (p=0.009), and developed complications (p=0.01) were higher in pandemic group.

Conclusion: Comparing prepandemic, although there was no statistically significant difference during the pandemic period, there was an increase in complicated appendicitis and related complications. It was attributed to late arrival at hospitals due to curfews, parental fear of disease transmission, and prolonged duration of screening tests in the emergency departments.

Keywords

• COVID-19 pandemic
• parental fair
• children
• acute appendicitis
• complicated appendicitis
• perforated appendicitis

COVID-19 Pandemisi Çocuklarda Apandisit Tanısının Konulmasında Gecikmelere Neden Oluyor mu?

Abstract

Amaç: Çalışmamızın amacı COVID-19 pandemisi sırasında komplike apandisit sayısında artış olup olmadığını araştırmaktır.

Gereç ve Yöntemler: Hastalar COVID-19 pandemisinin başladığı tarih esas alınarak, başvuru tarihlerine göre pre-pandemi ve pandemi grubu olmak üzere iki gruba ayrıldı ve verileri retrospektif olarak tarandı. Yaş, cinsiyet, şikayetlerin başlangıcından hastaneye gelene kadar geçen süre, WBC sayısı, hastaneye başvurudan ameliyat olana kadar geçen süre, uygulanan cerrahi yöntem, ameliyat esnasında apendiksin komplike olup olmadığı, hastanede kalış süreleri, komplikasyon gelişip gelişmediği ve PCR testlerinin sonuçları araştırıldı. Grupların verileri karşılaştırılarak aralarında fark olup olmadığı araştırıldı. İstatistiksel analiz SPSS (Statistical Package for Social Sciences) version 21 programı ile yapıldı. Tüm değişkenler için p <0.05 anlamlı kabul edildi.

Bulgular: Covid-19 pandemisi sırasında 327 hastaya, pandemi öncesi dönemde ise 295 hastaya apendektomi yapıldı. Pandemi sırasında komplike apandisit oranı pandemi öncesi döneme göre artmasına rağmen (%47.1’e karşı %40.7) gruplar arasında istatistiksel olarak fark bulunmadı. Ancak pre-pandemi grubu ile kıyaslandığında, pandemi grubunda semptomların başlangıcı ile hastaneye varış arasındaki süre (p = 0.003), ameliyattan önce geçen süre (p = 0.021), hastanede kalış süresi (p = 0.009) ve gelişen komplikasyonlar (p = 0.01) daha yüksek bulundu.

Sonuç: Pre-pandemi grubu ile kıyaslandığında, aralarında istatistiksel olarak fark tespit edilmemekle birlikte, Pandemi döneminde komplike apandisit ve buna bağlı komplikasyonlarda artış tespit edildi. Bu artış sokağa çıkma yasakları nedeniyle hastanelere geç başvurulması, ebeveynlerin bulaş korkusu ve acil servislerde tarama testlerinin uzun sürmesi ile ilişkilendirildi.

Keywords

• COVID-19 pandemisi
• ebeveynlerin bulaş korkusu
• çocuk
• akut apandisit
• komplike apandisit
• perfore apandisit

References

1. Coronavirus Update (Live) - https://www.worldometers.info/coronavirus/#countries, Accessed December 12, 2020. Access time: 22.07 p.m. (2020) https://www.worldometers.info/coronavirus/#countries. Accessed December 12, 2020, Access time: 22.07 p.m.
2. Svensson JF, Patkova B, Almstrom M, Eaton S, Wester T (2016) Outcome after introduction of laparoscopic appendectomy in children: A cohort study. J Pediatr Surg 51 (3):449-453. doi:10.1016/j.jpedsurg.2015.10.002
3. Dokumcu Z, Toker Kurtmen B, Divarci E, Tamay PB, Kose T, Sezak M, Ozok G, Ergun O, Celik A (2018) Retrospective Multivariate Analysis of Data from Children with Suspected Appendicitis: A New Tool for Diagnosis. Emerg Med Int 2018:4810730. doi:10.1155/2018/4810730
4. Dunn JCY (2012) Appendicitis. In: Coran AG (ed) Pediatric Surgery. pp 1255-1263. doi:http://dx.doi.org/10.1016/B978-0-323-07255-7.00100-8
5. Di Saverio S, Podda M, De Simone B, Ceresoli M, Augustin G, Gori A, et al. Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines. World J Emerg Surg. 2020;15:27.
6. Raffaele A, Cervone A, Ruffoli M, Cereda E, Avolio L, Parigi GB, et al. Critical factors conditioning the management of appendicitis in children during COVID-19 Pandemic: experience from the outbreak area of Lombardy, Italy. Br J Surg. 2020.
7. Snapiri O, Rosenberg Danziger C, Krause I, Kravarusic D, Yulevich A, Balla U, et al. Delayed diagnosis of paediatric appendicitis during the COVID-19 pandemic. Acta Paediatr. 2020;109:1672-6.
8. Lee-Archer P, Blackall S, Campbell H, Boyd D, Patel B, McBride C. Increased incidence of complicated appendicitis during the COVID-19 pandemic. J Paediatr Child Health. 2020;56:1313-4.

9. Turanli S, Kiziltan G. Did the COVID-19 Pandemic Cause a Delay in the Diagnosis of Acute Appendicitis? World J Surg. 2020.
10. Zhou Y, Cen LS. Managing acute appendicitis during the COVID-19 pandemic in Jiaxing, China. World J Clin Cases. 2020;8:4349-59.
11. Orthopoulos G, Santone E, Izzo F, Tirabassi M, Perez-Caraballo AM, Corriveau N, et al. Increasing incidence of complicated appendicitis during COVID-19 pandemic. Am J Surg. 2020.
12. Gunadi, Idham Y, Paramita VMW, Fauzi AR, Dwihantoro A, Makhmudi A. The Impact of COVID-19 pandemic on pediatric surgery practice: A cross-sectional study. Ann Med Surg (Lond). 2020;59:96-100.
13. Montalva L, Haffreingue A, Ali L, Clariot S, Julien-Marsollier F, Ghoneimi AE, et al. The role of a pediatric tertiary care center in avoiding collateral damage for children with acute appendicitis during the COVID-19 outbreak. Pediatr Surg Int. 2020.
14. Collard M, Lakkis Z, Loriau J, Mege D, Sabbagh C, Lefevre JH, et al. Antibiotics alone as an alternative to appendectomy for uncomplicated acute appendicitis in adults: Changes in treatment modalities related to the COVID-19 health crisis. J Visc Surg. 2020;157:S33-S42.
15. Polites SF, Azarow KS. Perspectives on Pediatric Appendicitis and Appendectomy During the Severe Acute Respiratory Syndrome Coronavirus 2 Pandemic. J Laparoendosc Adv Surg Tech A. 2020;30:356-7.
16. Kelly ME, Murphy E, Bolger JC, Cahill RA. COVID-19 and the treatment of acute appendicitis in Ireland: a new era or short-term pivot? Colorectal Dis. 2020;22:648-9.
17. Javanmard-Emamghissi H, Boyd-Carson H, Hollyman M, Doleman B, Adiamah A, Lund JN, et al. Correction to: The management of adult appendicitis during the COVID19 pandemic: an interim analysis of a UK cohort study. Tech Coloproctol. 2020.
18. Jones BA, Slater BJ. Non-operative management of acute appendicitis in a pediatric patient with concomitant COVID-19 infection. J Pediatr Surg Case Rep. 2020;59:101512.
19. Lee PI, Hu YL, Chen PY, Huang YC, Hsueh PR. Are children less susceptible to COVID-19? J Microbiol Immunol Infect. 2020;53:371-2.
20. Shen K, Yang Y, Wang T, Zhao D, Jiang Y, Jin R, et al. Diagnosis, treatment, and prevention of 2019 novel coronavirus infection in children: experts' consensus statement. World J Pediatr. 2020;16:223-31.
21. Pan L, Mu M, Yang P, Sun Y, Wang R, Yan J, et al. Clinical Characteristics of COVID-19 Patients With Digestive Symptoms in Hubei, China: A Descriptive, Cross-Sectional, Multicenter Study. Am J Gastroenterol. 2020;115:766-73.
22. Lishman J, Kohler C, de Vos C, van der Zalm MM, Itana J, Redfern A, et al. Acute Appendicitis in Multisystem Inflammatory Syndrome in Children With COVID-19. Pediatr Infect Dis J. 2020.
23. Tullie L, Ford K, Bisharat M, Watson T, Thakkar H, Mullassery D, et al. Gastrointestinal features in children with COVID-19: an observation of varied presentation in eight children. Lancet Child Adolesc Health. 2020;4:e19-e20.
24. Hassoun A, Kadenhe-Chiweshe A, Sharma M. New York's COVID-19 shelter-in-place and acute appendicitis in children. J Pediatr Surg. 2020.
25. Kvasnovsky CL, Shi Y, Rich BS, Glick RD, Soffer SZ, Lipskar AM, et al. Limiting hospital resources for acute appendicitis in children: Lessons learned from the U.S. epicenter of the COVID-19 pandemic. J Pediatr Surg. 2020.