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Miscia ME, Lauriti G, Di Renzo D, Cascini V, Lisi G. Management and outcomes of acute appendicitis in children during the COVID-19 pandemic: a systematic review and meta-analysis. Pediatr Surg Int 2023; 40:11. [PMID: 38017246 PMCID: PMC10684649 DOI: 10.1007/s00383-023-05594-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/03/2023] [Indexed: 11/30/2023]
Abstract
The COVID-19 pandemic has changed the way to manage the emergencies, as people faced fear of the hospitals, with possible delay in the diagnosis. Moreover, clinicians had to rearrange protocols for diagnosis and treatment. We aimed to assess whether COVID-19 pandemic influenced severity of inflammation, management, and outcomes of acute appendicitis (AA), when compared to the pre-COVID era. Using defined search strategy, two independent investigators identified those studies comparing pediatric AA during COVID-19 pandemic versus the pre-COVID-19 period. Meta-analysis was performed using RevMan 5.3. Data are mean ± SD. Of 528 abstracts, 36 comparative studies were included (32,704pts). Time from symptoms onset to surgery was longer during the pandemics compared to the pre-COVID-19 (1.6 ± 0.9 versus 1.4 ± 0.9 days; p < 0.00001). Minimally Invasive Surgery was similar during COVID-19 (70.4 ± 30.2%) versus control period (69.6 ± 25.3%; p = ns). Complicated appendicitis was increased during the pandemics (35.9 ± 14.8%) compared to control period (33.4 ± 17.2%; p < 0.0001). Post-operative complications were comparable between these two groups (7.7 ± 6.5% versus 9.1 ± 5.3%; p = ns). It seems that the COVID-19 pandemic influenced the time of diagnosis, severity of inflammation, and type of surgery. However, the number of post-operative complications was not different between the two groups, leading to the conclusion that the patients were correctly managed. LEVEL OF EVIDENCE: Level 3 Meta-analysis on Level 3 studies.
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Affiliation(s)
- Maria Enrica Miscia
- Department of Medicine and Aging Science, "G. d'Annunzio" University of Chieti-Pescara, Via L. Polacchi 11, 66100, Chieti, Italy
- Pediatric Surgery Unit, Spirito Santo" Hospital of Pescara, Pescara, Italy
| | - Giuseppe Lauriti
- Department of Medicine and Aging Science, "G. d'Annunzio" University of Chieti-Pescara, Via L. Polacchi 11, 66100, Chieti, Italy.
- Pediatric Surgery Unit, Spirito Santo" Hospital of Pescara, Pescara, Italy.
| | - Dacia Di Renzo
- Pediatric Surgery Unit, Spirito Santo" Hospital of Pescara, Pescara, Italy
| | - Valentina Cascini
- Pediatric Surgery Unit, Spirito Santo" Hospital of Pescara, Pescara, Italy
| | - Gabriele Lisi
- Department of Medicine and Aging Science, "G. d'Annunzio" University of Chieti-Pescara, Via L. Polacchi 11, 66100, Chieti, Italy
- Pediatric Surgery Unit, Spirito Santo" Hospital of Pescara, Pescara, Italy
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Mallikarjuna P, Goswami S, Ma S, Baik-Han W, Cervellione KL, Gulati G, Lew LQ. Comparison of Pediatric Acute Appendicitis Before and During the COVID-19 Pandemic in New York City. West J Emerg Med 2023; 24:956-961. [PMID: 37788037 PMCID: PMC10527842 DOI: 10.5811/westjem.59393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 03/27/2023] [Accepted: 05/25/2023] [Indexed: 10/04/2023] Open
Abstract
Background: Acute appendicitis (AA) is the most common abdominal surgical emergency in children and adolescents. In the year immediately following the declaration of the coronavirus disease 2019 (COVID-19) pandemic by the World Health Organization (WHO), there was a precipitous decline in emergency department (ED) visits especially for surgical conditions and infectious diseases. Fear of exposure to severe acute respiratory coronavirus 2 infection resulted in delay in presentation and time to surgery, and a shift toward more conservative management. Objective: Our goal was to compare the incidence and severity of AA before and during the COVID-19 pandemic. Methods: Patients aged 2-18 years admitted with the diagnosis of AA to Flushing Hospital Medical Center or Jamaica Hospital Medical Center in Queens, New York, were selected for chart review. Data extracted from electronic health records included demographics, clinical findings, imaging studies, and operative and pathological findings. We calculated the Alvarado score (AS) for incidence and the American Association for the Surgery of Trauma (AAST) grade for severity. We compared patients admitted between March 1, 2018-February 29, 2020 (pre-pandemic) to patients admitted between March 1, 2020-February 28, 2021 (pandemic). We then compared pre-pandemic and pandemic groups to determine differences in pediatric AA incidence and severity. Results: Of 239 patients diagnosed with AA, 184 (77%) were in the pre-pandemic group and 55 (23%) in the pandemic group. Incidence (number per year) of AA declined by 40%. The pandemic group had significantly greater overall AS of ≥7, indicating increased likelihood to require surgery, (P = 0.04) and higher AAST grade demonstrating increased severity (P = 0.02). Conclusion: There was a decline in the number of AA cases seen in our pediatric EDs and admitted during the first year of the pandemic. Clinicians need to be aware of increased severity of AA at time of presentation during public health emergencies such as a pandemic, possibly due to modified patient behavior.
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Affiliation(s)
- Priya Mallikarjuna
- Flushing Hospital Medical Center, Department of Pediatrics, Flushing, New York
| | - Saikat Goswami
- Flushing Hospital Medical Center, Department of Pediatrics, Flushing, New York
| | - Sandy Ma
- Flushing Hospital Medical Center, Department of Pediatrics, Flushing, New York
| | - Won Baik-Han
- Flushing Hospital Medical Center, Department of Pediatrics, Flushing, New York
| | | | - Gagan Gulati
- Flushing Hospital Medical Center, Department of Pediatrics, Flushing, New York
| | - Lily Q Lew
- Flushing Hospital Medical Center, Department of Pediatrics, Flushing, New York,
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Perveen S, Akhtar J, Ali S, Jabbar A. Feasibility of nonoperative treatment of acute appendicitis in children: a prospective cohort study. Singapore Med J 2023:384051. [PMID: 37675678 DOI: 10.4103/singaporemedj.smj-2021-406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
Introduction The management of acute appendicitis is a matter of debate even in contemporary era. Non-operative management is proposed as a valid treatment option for acute appendicitis in children. Methods A prospective cohort study was conducted from April 2020 to September 2021 at the National Institute of Child Health, Jinnah Sindh Medical University, Karachi, Pakistan, in children aged ≤ 12 years who were suspected of having acute appendicitis. Children with diffuse peritonitis and complex mass on ultrasonography were excluded. All children were kept nil per oral and started on intravenous fluid hydration and antibiotics. Statistical analyses were performed using IBM SPSS version 20. Chi-square test and Fisher's exact test were applied to determine the statistical significance. Results A total of 190 patients were admitted with a diagnosis of acute appendicitis. Thirty-two children with advanced disease underwent surgery. The remaining 158 patients were managed with nonoperative treatment. In 138 (87.3%) patients, resolution of symptoms occurred. Twenty (12.7%) patients underwent operation during the same admission (non-responders). Thirteen (9.4%) patients had recurrence of symptoms and underwent appendectomy. A total of 33 (20.9%) patients had appendectomy either at the primary admission or after discharge. Non-operative treatment was more likely to be successful in patients with symptoms of ≤ 24 h duration (P = 0.02), total leucocyte count of <12 × 109 cells/L (P = 0.005) and smaller size of the appendix on ultrasound (P = 0.001). Conclusion Among children with uncomplicated acute appendicitis, a non-operative approach resulted in resolution of symptoms in 87.3% of patients at the initial admission. Failure of non-operative treatment and recurrence of disease after discharge from the hospital occurred in 9.4% of patients after successful initial treatment. Thus, the overall success rate at a mean follow-up of 3 months was about 78%.
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Affiliation(s)
- Shazia Perveen
- Department of Paediatric Surgery, National Institute of Child Health, Jinnah Sindh Medical University, Karachi, Pakistan
| | - Jamshed Akhtar
- Department of Paediatric Surgery, National Institute of Child Health, Jinnah Sindh Medical University, Karachi, Pakistan
| | - Sajid Ali
- Department of Paediatric Surgery, National Institute of Child Health, Jinnah Sindh Medical University, Karachi, Pakistan
| | - Abdul Jabbar
- Department of Paediatric Surgery, National Institute of Child Health, Jinnah Sindh Medical University, Karachi, Pakistan
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Pantalos G, Papachristidou S, Mavrigiannaki E, Zavras N, Vaos G. Reasons for Delayed Diagnosis of Pediatric Acute Appendicitis during the COVID-19 Era: A Narrative Review. Diagnostics (Basel) 2023; 13:2571. [PMID: 37568934 PMCID: PMC10417690 DOI: 10.3390/diagnostics13152571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 07/21/2023] [Accepted: 07/31/2023] [Indexed: 08/13/2023] Open
Abstract
Global pandemics cause health system disruptions. The inadvertent disruption in surgical emergency care during the Coronavirus Disease 2019 (COVID-19) pandemic has been the topic of several published studies. Our aim was to summarize the reasons that led to the delayed diagnosis of pediatric appendicitis during the COVID-19 era. This systematic literature search evaluated studies containing pediatric appendicitis patient data regarding outcomes, times to hospital admission or times from symptom onset to emergency department visit. Studies elucidating reasons for delays in the management of pediatric appendicitis were also reviewed. Ultimately, 42 studies were included. Several reasons for delayed diagnosis are analyzed such as changes to public health measures, fear of exposure to COVID-19, increased use of telemedicine, COVID-19 infection with concurrent acute appendicitis, recurrence of appendicitis after non-operative management and increased time to intraoperative diagnosis. Time to hospital admission in conjunction with patient outcomes was extracted and analyzed as an indicative measure of delayed management. Delayed diagnosis of acute appendicitis has been documented in many studies with various effects on outcomes. Suspicion of pediatric acute appendicitis must always lead to prompt medical examination, regardless of pandemic status. Telemedicine can be valuable if properly applied. Data from this era can guide future health system policies.
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Affiliation(s)
- George Pantalos
- Pediatric Intensive Care Unit, Penteli General Children’s Hospital, 15236 Athens, Greece
| | - Smaragda Papachristidou
- Second Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, P. & A. Kyriakou Children’s Hospital, 11527 Athens, Greece;
| | - Eleftheria Mavrigiannaki
- Department of Pediatric Surgery, School of Medicine, National and Kapodistrian University of Athens, “Attikon” General University Hospital, 12462 Athens, Greece; (E.M.); (G.V.)
| | - Nikolaos Zavras
- Department of Pediatric Surgery, School of Medicine, National and Kapodistrian University of Athens, “Attikon” General University Hospital, 12462 Athens, Greece; (E.M.); (G.V.)
| | - George Vaos
- Department of Pediatric Surgery, School of Medicine, National and Kapodistrian University of Athens, “Attikon” General University Hospital, 12462 Athens, Greece; (E.M.); (G.V.)
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Andersson RE, Agiorgiti M, Bendtsen M. Spontaneous Resolution of Uncomplicated Appendicitis may Explain Increase in Proportion of Complicated Appendicitis During Covid-19 Pandemic: a Systematic Review and Meta-analysis. World J Surg 2023; 47:1901-1916. [PMID: 37140609 PMCID: PMC10158710 DOI: 10.1007/s00268-023-07027-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2023] [Indexed: 05/05/2023]
Abstract
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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Affiliation(s)
- Roland E Andersson
- Department of Surgery, County Hospital Ryhov, Box 1024, SE 551 11, Jönköping, Region Jönköpings Län, Sweden.
- Futurum, Academy for Health and Care, Jönköping, Region Jönköpings Län, Sweden.
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
| | - Maria Agiorgiti
- Bra Liv Eksjö Primary Care Centre, Eksjö, Region Jönköping County, Sweden
- Department of Experimental Physiology, Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | - Marcus Bendtsen
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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Hegde B, Garcia E, Hu A, Raval M, Takirambudde S, Wakeman D, Lewit R, Gosain A, Parrado RH, Cina RA, Stephenson K, Dassinger MS, Zhang D, Mustafa MM, Koo D, Lipskar AM, Scheidler K, Van Arendonk KJ, Berg P, Gonzalez R, Scheese D, Haynes J, Mina A, Zamora IJ, Lopez ME, Mehl SC, Gilliam E, Lofberg K, Spencer B, Kulaylat AN, Gulack BC, Johnson M, Laskovy M, Brahmamdam P, Shimomura A, Blanch T, Tsao K, Slater BJ. Management of pediatric appendicitis during the COVID-19 pandemic: A nationwide multicenter cohort study. J Pediatr Surg 2023; 58:1375-1382. [PMID: 36075771 PMCID: PMC9374489 DOI: 10.1016/j.jpedsurg.2022.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 07/22/2022] [Accepted: 08/08/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND The COVID-19 pandemic has impacted timely access to care for children, including patients with appendicitis. This study aimed to evaluate the effect of the COVID-19 pandemic on management of appendicitis and patient outcomes. METHODS A multicenter retrospective study was performed including 19 children's hospitals from April 2019-October 2020 of children (age≤18 years) diagnosed with appendicitis. Groups were defined by each hospital's city/state stay-at-home orders (SAHO), designating patients as Pre-COVID (Pre-SAHO) or COVID (Post-SAHO). Demographic, treatment, and outcome data were obtained, and univariate and multivariable analysis was performed. RESULTS Of 6,014 patients, 2,413 (40.1%) presented during the COVID-19 pandemic. More patients were managed non-operatively during the COVID-19 pandemic compared to before the pandemic (147 (6.1%) vs 144 (4.0%), p < 0.001). Despite this change, there was no difference in the proportion of complicated appendicitis between groups (1,247 (34.6%) vs 849 (35.2%), p = 0.12). COVID era non-operative patients received fewer additional procedures, including interventional radiology (IR) drain placements, compared to pre-COVID non-operative patients (29 (19.7%) vs 69 (47.9%), p < 0.001). On adjusted analysis, factors associated with increased odds of receiving non-operative management included: increasing duration of symptoms (OR=1.01, 95% CI: 1.01-1.012), African American race (OR=2.4, 95% CI: 1.3-4.6), and testing positive for COVID-19 (OR=10.8, 95% CI: 5.4-21.6). CONCLUSION Non-operative management of appendicitis increased during the COVID-19 pandemic. Additionally, fewer COVID era cases required IR procedures. These changes in the management of pediatric appendicitis during the COVID pandemic demonstrates the potential for future utilization of non-operative management.
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Affiliation(s)
- Brittany Hegde
- Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 5.256, Houston, TX 77030, United States of America; Center for Surgical Trials and Evidence-based Practice (C-STEP), McGovern Medical School at the University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 5.256, Houston, TX 77030, United States of America; Children's Memorial Hermann Hospital, 6411 Fannin Street, Houston, TX 77030, United States of America
| | - Elisa Garcia
- Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 5.256, Houston, TX 77030, United States of America; Children's Memorial Hermann Hospital, 6411 Fannin Street, Houston, TX 77030, United States of America
| | - Andrew Hu
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave, Chicago, IL 60611, United States of America
| | - Mehul Raval
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave, Chicago, IL 60611, United States of America
| | - Sanyu Takirambudde
- University of Rochester School of Medicine and Dentistry, 601 Elmwood Ave, Rochester, NY 14642, United States of America
| | - Derek Wakeman
- University of Rochester School of Medicine and Dentistry, 601 Elmwood Ave, Rochester, NY 14642, United States of America
| | - Ruth Lewit
- University of Tennessee Health Science Center, LeBonheur Children's Hospital, 49 North Dunlap, Memphis, TN 38103, United States of America
| | - Ankush Gosain
- University of Tennessee Health Science Center, LeBonheur Children's Hospital, 49 North Dunlap, Memphis, TN 38103, United States of America
| | - Raphael H Parrado
- Medical University of South Carolina, Shawn Jenkins Children's Hospital, 10 McClennan Banks Drive, Charleston, SC 29425, United States of America
| | - Robert A Cina
- Medical University of South Carolina, Shawn Jenkins Children's Hospital, 10 McClennan Banks Drive, Charleston, SC 29425, United States of America
| | - Krista Stephenson
- Arkansas Children's Hospital, 1 Children's Way, Slot 837, Little Rock, AR 72202, United States of America
| | - Melvin S Dassinger
- Arkansas Children's Hospital, 1 Children's Way, Slot 837, Little Rock, AR 72202, United States of America
| | - Daniel Zhang
- University of Florida Health Shands Children's Hospital, 1515 SW Archer Rd, Gainesville, FL 32608, United States of America
| | - Moiz M Mustafa
- University of Florida Health Shands Children's Hospital, 1515 SW Archer Rd, Gainesville, FL 32608, United States of America
| | - Donna Koo
- Cohen Children's Medical Center, Zucker School of Medicine at Hofstra/Northwell, Division of Pediatric Surgery, 1111 Marcus Avenue, Ste M15, New Hyde Park, NY 11042, United States of America
| | - Aaron M Lipskar
- Cohen Children's Medical Center, Zucker School of Medicine at Hofstra/Northwell, Division of Pediatric Surgery, 1111 Marcus Avenue, Ste M15, New Hyde Park, NY 11042, United States of America
| | - Katherine Scheidler
- Division of Pediatric Surgery, Medical College of Wisconsin, 999N 92nd St, Suite 320, Milwaukee, WI 53226, United States of America
| | - Kyle J Van Arendonk
- Division of Pediatric Surgery, Medical College of Wisconsin, 999N 92nd St, Suite 320, Milwaukee, WI 53226, United States of America
| | - Patrick Berg
- University of California Davis, School of Medicine, Department of Surgery, Division of Trauma, Acute Care Surgery, and Surgical Critical Care, 2335 Stockton Blvd. 5th floor, Sacramento, CA 95817, United States of America
| | - Raquel Gonzalez
- Johns Hopkins All Children's Hospital, 601 5th Street South, Suite 611, St. Petersburg, FL 33701, United States of America
| | - Daniel Scheese
- Childrens Hospital of Richmond, VCU Health System, 1200 E Marshall St, Richmond, VA 23298, United States of America
| | - Jeffrey Haynes
- Childrens Hospital of Richmond, VCU Health System, 1200 E Marshall St, Richmond, VA 23298, United States of America
| | - Alexander Mina
- Vanderbilt University Medical Center, 2200 Children's Way, DOT 7, Nashville, TN 37212, United States of America
| | - Irving J Zamora
- Vanderbilt University Medical Center, 2200 Children's Way, DOT 7, Nashville, TN 37212, United States of America
| | - Monica E Lopez
- Vanderbilt University Medical Center, 2200 Children's Way, DOT 7, Nashville, TN 37212, United States of America
| | - Steven C Mehl
- Texas Children's Hospital, Baylor College of Medicine, 6701 Fannin Street, Suite 1210, Houston, TX 77030, United States of America
| | - Elizabeth Gilliam
- Oregon Health and Science University, Division of Pediatric Surgery, 3181 SW Sam Jackson Rd, Portland, OR 97239, United States of America
| | - Katrina Lofberg
- Oregon Health and Science University, Division of Pediatric Surgery, 3181 SW Sam Jackson Rd, Portland, OR 97239, United States of America
| | - Brianna Spencer
- Penn State Health Children's Hospital, 600 University Drive, Hershey, PA 17033, United States of America
| | - Afif N Kulaylat
- Penn State Health Children's Hospital, 600 University Drive, Hershey, PA 17033, United States of America
| | - Brian C Gulack
- Rush University Medical Center, Department of Surgery, 1653W. Congress Pkwy, Chicago, IL 60612, United States of America
| | - Matthew Johnson
- Rush University Medical Center, Department of Surgery, 1653W. Congress Pkwy, Chicago, IL 60612, United States of America
| | - Matthew Laskovy
- Beaumont Health, Department of Surgery, 3811 West 13 Mile Rd, Suite e181, Royal Oak, MI 48073, United States of America
| | - Pavan Brahmamdam
- Beaumont Health, Department of Surgery, 3811 West 13 Mile Rd, Suite e181, Royal Oak, MI 48073, United States of America
| | - Aoi Shimomura
- Loyola University Chicago, Stritch School of Medicine, 2160 S 1st Avenue, Maywood, IL 60153, United States of America
| | - Therese Blanch
- Loyola University Chicago, Stritch School of Medicine, 2160 S 1st Avenue, Maywood, IL 60153, United States of America
| | - KuoJen Tsao
- Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 5.256, Houston, TX 77030, United States of America; Center for Surgical Trials and Evidence-based Practice (C-STEP), McGovern Medical School at the University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 5.256, Houston, TX 77030, United States of America; Children's Memorial Hermann Hospital, 6411 Fannin Street, Houston, TX 77030, United States of America
| | - Bethany J Slater
- Comer Children's Hospital, University of Chicago, 5721 S Maryland Avenue, Chicago, IL 60637, United States of America.
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Kaselas C, Florou M, Tsopozidi M, Spyridakis I. Acute Appendicitis Following COVID-19 Infection in Pediatric Patients: A Single Center's Study in Greece. Diagnostics (Basel) 2023; 13:2070. [PMID: 37370965 PMCID: PMC10297295 DOI: 10.3390/diagnostics13122070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/31/2023] [Accepted: 06/12/2023] [Indexed: 06/29/2023] Open
Abstract
PURPOSE This study investigated the potential association between the previous severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positive infection, as well as vaccination, and the presentation of acute appendicitis in pediatric patients. It has been three years since the World Health Organization (WHO) declared the SARS-CoV-2 pandemic, and city lockdowns and self-protective measures have been applied worldwide. In an effort to contribute to the research on the probable long-term complications of the COVID-19 infection as well as the vaccination against SARS-CoV-2, the current study was designed and investigated patients' health records in the post-quarantine era. METHODS A retrospective analysis of patients admitted and treated surgically for acute appendicitis from January 2022 to June 2022 was conducted. Demographic and personal data, as well as the COVID-19 infection history of each child, were recorded. The patients who were negative for a previous COVID-19 infection were excluded. For the rest of the sample, the time-to-onset of acute appendicitis, the severity of appendicitis (complicated or uncomplicated), and the vaccination status of the patients were examined. Regarding the time-to-onset of appendicitis, we divided the patients into three groups: group A with a time-to-onset < 3 months, group B with a time-to-onset of 3-6 months, and group C with a time-to-onset of >6 months. Statistical analysis followed and was considered significant if p < 0.05. RESULTS Sixty-six children with a mean age of 10.5 years (range 1-15 years) were admitted for acute appendicitis during the determined period. After excluding 30 children that were negative for previous COVID-19 infection, we divided the patients into three groups: group A-23 children, group B-7 children, and group C-6 children. A statistically significant incidence of acute appendicitis diagnosis in <3 months after laboratory-confirmed COVID-19 infection (p < 0.01) was found. The incidence of complicated appendicitis was greater in patients with a positive SARS-CoV-2 history, with an estimated odds ratio of 1.8 (p > 0.05). The majority of the children (92%) had not received a COVID-19 vaccination. For the vaccinated children, the relative risk for complicated appendicitis was equal to 1.5 (p > 0.05). CONCLUSIONS The results of our study demonstrate a potential positive relationship between COVID-19 infection and subsequent acute appendicitis in pediatric patients. There are also some speculations on the presentation of complicated cases of appendicitis following COVID-19 infection or vaccination, but these need to be further proven. Further data are required to better understand this potential complication of COVID-19 infection as well as the role of vaccines in the current post-vaccine era.
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Affiliation(s)
| | - Maria Florou
- Second Department of Pediatric Surgery, Aristotle University of Thessaloniki, “Papageorgiou’’ General Hospital Thessaloniki, 54124 Thessaloniki, Greece
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8
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Iantorno SE, Skarda DE, Bucher BT. Concurrent SARS-COV-19 and acute appendicitis: Management and outcomes across United States children's hospitals. Surgery 2023; 173:936-943. [PMID: 36621446 PMCID: PMC9820025 DOI: 10.1016/j.surg.2022.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 12/02/2022] [Accepted: 12/11/2022] [Indexed: 01/08/2023]
Abstract
BACKGROUND Nonoperative management of acute appendicitis is a safe and effective alternative to appendectomy, though rates of treatment failure and disease recurrence are significant. The purpose of this study was to determine whether COVID-19-positive children with acute appendicitis were more likely to undergo nonoperative management when compared to COVID-19-negative peers and to compare clinical outcomes and healthcare use for these groups. METHODS A retrospective cohort study of children <18 years with acute appendicitis across 45 US Children's Hospitals during the first 12 months of the COVID-19 pandemic was performed. Operative management was defined as appendectomy or percutaneous drain placement, whereas nonoperative management was defined as admission with antibiotics alone. Multivariable hierarchical logistic regression using an exact matched cohort was used to determine the association between COVID-19 positivity and nonoperative management. The secondary outcomes included intensive care unit admission, mechanical ventilation, length of stay, nonoperative management failure rates, and hospital variation in nonoperative management. RESULTS Of 17,481 children in the cohort, 581 (3.3%) were positive for COVID-19. The odds of nonoperative management was significantly higher in the COVID-19-positive group (adjusted odds ratio [95% confidence interval]: 13.4 [10.7-16.8], P < .001). Patients positive for COVID-19 had increased odds of intensive care unit admission (adjusted odds ratio [95% confidence interval]: 3.78 [2.01-7.12], P < .001) and longer length of stay (median 2 days vs 1 day, P < .001). Hospital rates of nonoperative management ranged from 0% to 100% for COVID-19-positive patients and 0% to 42% for COVID-19-negative patients. CONCLUSION Children with concurrent acute appendicitis and COVID-19 positivity are significantly more likely to undergo nonoperative management. Both groups experience infrequent nonoperative management failure rates and rare intensive care unit admissions. Marked hospital variability in nonoperative management practices was demonstrated.
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Affiliation(s)
- Stephanie E Iantorno
- Division of Pediatric Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT.
| | - David E Skarda
- Division of Pediatric Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT
| | - Brian T Bucher
- Division of Pediatric Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT
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9
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Raeisi R, Azizi M, Amiri J, Ghorbanpour M, Esna-Ashari F. Accuracy Evaluation of Pediatric Appendicitis Scoring (PAS) Method in Differentiating Nonspecific Abdominal Pain from Appendicitis. Int J Prev Med 2023; 14:40. [PMID: 37351062 PMCID: PMC10284213 DOI: 10.4103/ijpvm.ijpvm_539_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 10/27/2022] [Indexed: 06/24/2023] Open
Abstract
Background This study aimed at evaluating the accuracy of the pediatric appendicitis scoring method in differentiating nonspecific abdominal pain (NSAP) from appendicitis. Methods This cross-sectional study was conducted on 391 children who were hospitalized in the emergency ward due to acute abdominal pain suspected of appendicitis . Pediatric Appendicitis Score (PAS), C-reactive protein (CRP), and appendicitis pathology results of patients undergoing surgery were recorded. Results The results showed that the no significant difference was found among patients in the three experimental groups (appendicitis, specific abdominal pain except appendicitis, and NSAP) with respect to temperature (p = 0.212), but the other variables were significantly different. Findings showed that high CRP frequency, pain migration to right lower quadrant (RLQ), tenderness in right iliac fossa (RIF), anorexia, leukocytosis, high neutrophil, and mean tenderness in RLQ in the appendicitis group were higher than those in the other two groups (p = 0.001). The PAS questionnaire can also be used as a reliable questionnaire with appropriate sensitivity (0.929) and specificity (0.993), and this questionnaire along with detailed clinical examinations could reduce the rate of negative appendectomy to less than 1%. Conclusions This study showed high accuracy of PAS in diagnosing children with appendicitis and differentiating appendicitis from cases of NSAP and specific abdominal pain other than appendicitis. The PAS system could also significantly reduce cases of negative appendicitis. Although high CRP had an excellent ability to diagnose appendicitis, its accuracy was lower than PAS.
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Affiliation(s)
- Roya Raeisi
- Department of Pediatrics, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mona Azizi
- Department of Pediatrics, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Jalaleddin Amiri
- Department of Pediatrics, Hamadan University of Medical Sciences, Hamadan, Iran
| | | | - Farzaneh Esna-Ashari
- Community Medicine, Faculty of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
- School of Public Health and Research Center for Health Sciences, Hamadan University of Medical Sciences, Hamadan, Iran
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10
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Ayyıldız HN, Mirapoglu S, Yıldız ZA, Şahin C, Güvenç FT, Arpacık M, İlce Z. What has changed in children's appendicitis during the COVID-19 pandemic? ULUS TRAVMA ACIL CER 2022; 28:1674-1681. [PMID: 36453784 PMCID: PMC10198316 DOI: 10.14744/tjtes.2021.51000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 11/12/2021] [Indexed: 06/04/2023]
Abstract
BACKGROUND The present study aimed to investigate the changes in the course of acute appendicitis during the pandemic period by comparing the cases treated during the coronavirus disease 2019 (COVID-19) pandemic with those in the pre-pandemic period. METHODS The study was conducted with 601 children aged 1-18 years who were operated for acute appendicitis between May 1, 2019, and February 29, 2020 (Group I) and between March 1 and December 31, 2020 (Group II). The demographic and disease characteristics as well as the treatment processes were compared between the groups. RESULTS It was found that 59.1% (n=355) of the cases included in the study were in Group I and 40.9% (n=246) were in Group II. During the pandemic period; due to the concerns of families about contracting a contagious disease for both themselves and their children, and warnings by health professionals and government officials that they should not leave their homes and not come to the hospital unless there is an emergency, the time to apply to the hospital has been extended. Before the pandemic, 20.3% of the patients presented to the hospital on the 1st day of their complaints, where during the pandemic, only 2% of the patients reported to the hospital on the 1st day, and 15% presented after 4 days or more. As a result, the rate of perforated appendicitis, which was formerly 10.4%, increased to 24.8% during the pandemic period (p<0.01). During the pandemic, we operated on four patients with positive COVID-19 test results. There were no complications related to COVID-19 and surgery in our patients. CONCLUSION Concern of the current pandemic resulted in late presentation to the hospital, increase in the number of perforated appendicitis, and prolonged hospital stay.
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Affiliation(s)
- Hayriye Nihan Ayyıldız
- Department of Pediatric Surgery, University of Health Sciences, Ümraniye Training and Research Hospital, İstanbul-Türkiye
| | - Semih Mirapoglu
- Department of Pediatric Surgery, University of Health Sciences, Ümraniye Training and Research Hospital, İstanbul-Türkiye
| | - Zeliha Akış Yıldız
- Department of Pediatric Surgery, University of Health Sciences, Ümraniye Training and Research Hospital, İstanbul-Türkiye
| | - Ceyhan Şahin
- Department of Pediatric Surgery, University of Health Sciences, Ümraniye Training and Research Hospital, İstanbul-Türkiye
| | - Fatma Tuğba Güvenç
- Department of Pediatric Surgery, University of Health Sciences, Ümraniye Training and Research Hospital, İstanbul-Türkiye
| | - Mehmet Arpacık
- Department of Pediatric Surgery, University of Health Sciences, Ümraniye Training and Research Hospital, İstanbul-Türkiye
| | - Zekeriya İlce
- Department of Pediatric Surgery, University of Health Sciences, Ümraniye Training and Research Hospital, İstanbul-Türkiye
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11
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Ghazwani SM. Moving to Medical Treatment for COVID-19 Influence on Pediatric Appendicitis: A Meta-Analysis. Cureus 2022; 14:e32601. [PMID: 36654629 PMCID: PMC9840872 DOI: 10.7759/cureus.32601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2022] [Indexed: 12/23/2022] Open
Abstract
Acute appendicitis (AA) is cited as the leading cause of surgical acute abdomen in pediatrics and the most frequent urgent surgical pathology worldwide. For a long time, surgical appendectomy has been effectively used as the first-line treatment for AA. Other conservative management practices, such as the use of antibiotics, have been applied in the treatment of appendicitis. COVID-19 has had a significant impact on the surgical treatment strategies of AA in pediatrics, with many pediatric surgeons having to shift from upfront surgical appendectomy to conservative management involving the use of antibiotics as a treatment strategy. This meta-analysis compares the outcomes between appendectomy and conservative therapy in the management of AA during COVID-19 in pediatrics. Twenty-one articles fully met the inclusion criteria. Articles that were published more than five years ago were excluded from the analysis. Also, articles that included studies on the adult population were excluded. Results from various retrospective studies, prospective clinical controlled trials, correlational studies, and randomized clinical trials were analyzed. This study reveals that the use of antibiotics has been demonstrated to be safe and effective in the treatment of uncomplicated appendicitis. However, antibiotics have been shown to have some complications. Despite this being the case, the studies identified the potential of using antibiotics as a definitive treatment of uncomplicated AA in pediatrics. Further studies are required to evaluate the cost-effectiveness and recurrence of AA of this alternative treatment method.
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12
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Cassell K, Zipfel CM, Bansal S, Weinberger DM. Trends in non-COVID-19 hospitalizations prior to and during the COVID-19 pandemic period, United States, 2017-2021. Nat Commun 2022; 13:5930. [PMID: 36209210 PMCID: PMC9546751 DOI: 10.1038/s41467-022-33686-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 09/28/2022] [Indexed: 11/08/2022] Open
Abstract
COVID-19 pandemic-related shifts in healthcare utilization, in combination with trends in non-COVID-19 disease transmission and non-pharmaceutical intervention use, had clear impacts on rates of hospitalization for infectious and chronic diseases. Using a U.S. national healthcare billing database, we estimated the monthly incidence rate ratio of hospitalizations between March 2020 and June 2021 according to 19 ICD-10 diagnostic chapters and 189 subchapters. The majority of primary diagnoses for hospitalization showed an immediate decline in incidence during March 2020. Hospitalizations for reproductive neoplasms, hypertension, and diabetes returned to pre-pandemic levels during late 2020 and early 2021, while others, like those for infectious respiratory disease, did not return to pre-pandemic levels during this period. Our assessment of subchapter-level primary hospitalization codes offers insight into trends among less frequent causes of hospitalization during the COVID-19 pandemic in the U.S.
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Affiliation(s)
- Kelsie Cassell
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA.
| | - Casey M Zipfel
- Department of Biology, Georgetown University, Washington, DC, USA
| | - Shweta Bansal
- Department of Biology, Georgetown University, Washington, DC, USA
| | - Daniel M Weinberger
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
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13
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Castro AD, Mayr FB, Talisa VB, Shaikh OS, Omer SB, Yende S, Butt AA. Variation in Clinical Treatment and Outcomes by Race Among US Veterans Hospitalized With COVID-19. JAMA Netw Open 2022; 5:e2238507. [PMID: 36282499 PMCID: PMC9597393 DOI: 10.1001/jamanetworkopen.2022.38507] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 09/11/2022] [Indexed: 12/15/2022] Open
Abstract
Importance Patients from racially and ethnically minoritized populations, such as Black and Hispanic patients, may be less likely to receive evidence-based COVID-19 treatments than White patients, contributing to adverse clinical outcomes. Objective To determine whether clinical treatments and outcomes among patients hospitalized with COVID-19 were associated with race. Design, Setting, and Participants This retrospective cohort study was conducted in 130 Department of Veterans Affairs Medical Centers (VAMCs) between March 1, 2020, and February 28, 2022, with a 60-day follow-up period until May 1, 2022. Participants included veterans hospitalized with COVID-19. Data were analyzed from May 6 to June 2, 2022. Exposures Self-reported race. Main Outcomes and Measures Clinical care processes (eg, intensive care unit [ICU] admission; organ support measures, including invasive and noninvasive mechanical ventilation; prone position therapy, and COVID-19-specific medical treatments) were quantified. Clinical outcomes of interest included in-hospital mortality, 60-day mortality, and 30-day readmissions. Outcomes were assessed with multivariable random effects logistic regression models to estimate the association of race with outcomes not attributable to known mediators, such as socioeconomic status and age, while adjusting for potential confounding between outcomes and mediators. Results A total of 43 222 veterans (12 135 Black veterans [28.1%]; 31 087 White veterans [71.9%]; 40 717 [94.2%] men) with a median (IQR) age of 71 (62-77) years who were hospitalized with SARS-CoV-2 infection were included. Controlling for site of treatment, Black patients were equally likely to be admitted to the ICU (4806 Black patients [39.6%] vs 13 427 White patients [43.2%]; within-center adjusted odds ratio [aOR], 0.95; 95% CI, 0.88-1.02; P = .17). Two-thirds of patients treated with supplemental oxygen or noninvasive or invasive mechanical ventilation also received systemic steroids, but Black veterans were less likely to receive steroids (within-center aOR, 0.88; 95% CI, 0.80-0.96; P = .004; between-center aOR, 0.67; 95% CI, 0.48-0.96; P = .03). Similarly, Black patients were less likely to receive remdesivir (within-center aOR, 0.89; 95% CI, 0.83-0.95; P < .001; between-center aOR, 0.68; 95% CI, 0.47-0.99; P = .02) or treatment with immunomodulatory drugs (within-center aOR, 0.77; 95% CI, 0.67-0.87; P < .001). After adjusting for patient demographic characteristics, chronic health conditions, severity of acute illness, and receipt of COVID-19-specific treatments, there was no association of Black race with hospital mortality (within-center aOR, 0.98; 95% CI, 0.86-1.10; P = .71) or 30-day readmission (within-center aOR, 0.95; 95% CI, 0.88-1.04; P = .28). Conclusions and Relevance These findings suggest that Black veterans hospitalized with COVID-19 were less likely to be treated with evidence-based COVID-19 treatments, including systemic steroids, remdesivir, and immunomodulatory drugs.
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Affiliation(s)
| | - Florian B. Mayr
- VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
- Clinical Research, Investigation, and Systems Modeling of Acute Illness Center, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Victor B. Talisa
- VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
- Clinical Research, Investigation, and Systems Modeling of Acute Illness Center, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Obaid S. Shaikh
- VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
- Division of Gastroenterology, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Saad B. Omer
- Institute for Global Health, Yale University, New Haven, Connecticut
| | - Sachin Yende
- VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
- Clinical Research, Investigation, and Systems Modeling of Acute Illness Center, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Adeel A. Butt
- VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
- Department of Medicine, Weill Cornell Medicine, Doha, Qatar
- Department of Population Health Sciences, Weill Cornell Medicine, Doha, Qatar
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14
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Carlisle EM, Shakhsheer BA. Ethical Issues Related to the COVID-19 Pandemic That Have Influenced Pediatric Surgery. Pediatr Ann 2022; 51:e306-e310. [PMID: 35938892 DOI: 10.3928/19382359-20220606-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The response of the health care system to pediatric surgical patients has been dramatically altered by the coronavirus disease 2019 pandemic. Such changes have affected children, families, and the clinicians who care for them. In this review, we highlight some of the ethical issues faced by pediatric surgical patients and pediatric surgeons during the coronavirus disease 2019 pandemic, including the transition to public health ethics, scarcity of resources, exacerbation of disparities, moral distress for pediatric surgeons, and shifting reliance on telemedicine and other remote means of communication. We discuss how these issues have prompted both favorable and unfavorable changes to the surgical care of children and consider which changes may have a lasting effect on pediatric surgery. [Pediatr Ann. 2022;51(8):e306-e310.].
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15
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Hegde BN, Slater BJ. Long-Term Effect of the COVID-19 Pandemic on the Management of Pediatric Appendicitis. Pediatr Ann 2022; 51:e266-e269. [PMID: 35858217 DOI: 10.3928/19382359-20220504-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Appendicitis remains a common disease entity in pediatric patients that has historically been treated surgically with appendectomy as the standard of care. The coronavirus disease 2019 (COVID-19) pandemic introduced widespread challenges impacting the management and treatment of various disease processes, including pediatric appendicitis. Many studies demonstrated a decreased incidence in pediatric appendicitis cases, which may be attributable to fears of contracting the COVID-19 virus and restrictions imposed with stay-at-home orders. Many studies have noted both an increase in nonoperative management of pediatric appendicitis and a rise in patients presenting with complicated appendicitis. Additionally, the development of multisystem inflammatory syndrome in children that may present with symptoms mimicking appendicitis has created a diagnostic dilemma for pediatric care providers. Understanding the natural history of pediatric appendicitis during the COVID-19 pandemic and additional diagnostic and treatment difficulties are essential to ensure accurate care of pediatric patients that present with abdominal pain concerning for appendicitis. [Pediatr Ann. 2022;51(7):e266-e269.].
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16
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Levy M, Lestrade V, Said C, Jouvet P, Kawaguchi A. Consequences of Social Distancing Measures During the COVID-19 Pandemic First Wave on the Epidemiology of Children Admitted to Pediatric Emergency Departments and Pediatric Intensive Care Units: A Systematic Review. Front Pediatr 2022; 10:874045. [PMID: 35722481 PMCID: PMC9204064 DOI: 10.3389/fped.2022.874045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 04/28/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives To synthesize knowledge describing the impact of social distancing measures (SDM) during the first wave of the COVID-19 pandemic on acute illness in children by focusing on the admission to pediatric emergency departments (PED) and pediatric intensive care units (PICU). Methods We searched Cochrane Database of Systematic Reviews, Cochrane Controlled Trials Register, EPOC Register, MEDLINE, Evidence-Based Medicine Reviews, EMBASE, WHO database on COVID-19, Cochrane Resources on COVID-19, Oxford COVID-19 Evidence Service, Google Scholar for literature on COVID-19 including pre-print engines such as medRxiv, bioRxiv, Litcovid and SSRN for unpublished studies on COVID-19 in December 2020. We did not apply study design filtering. The primary outcomes of interest were the global incidence of admission to PICU and PED, disease etiologies, and elective/emergency surgeries, compared to the historical cohort in each studied region, country, or hospital. Results We identified 6,660 records and eighty-seven articles met our inclusion criteria. All the studies were with before and after study design compared with the historical data, with an overall high risk of bias. The median daily PED admissions decreased to 65% in 39 included studies and a 54% reduction in PICU admission in eight studies. A significant decline was reported in acute respiratory illness and LRTI in five studies with a median decrease of 63%. We did not find a consistent trend in the incidence of poisoning, but there was an increasing trend in burns, DKA, and a downward trend in trauma and unplanned surgeries. Conclusions SDMs in the first wave of the COVID-19 pandemic reduced the global incidence of pediatric acute illnesses. However, some disease groups, such as burns and DKA, showed a tendency to increase and its severity of illness at hospital presentation. Continual effort and research into the subject should be essential for us to better understand the effects of this new phenomenon of SDMs to protect the well-being of children. Systematic Review Registration Clinicaltrials.gov, identifier: CRD42020221215.
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Affiliation(s)
- Michael Levy
- Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Pediatric Critical Care, University of Montreal, Montréal, QC, Canada
- Pediatric Intensive Care Unit, Centre Hospitalier Universitaire Robert-Debré, Assistance Publique Hôpitaux de Paris, Université de Paris, Paris, France
| | - Victor Lestrade
- Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Pediatric Critical Care, University of Montreal, Montréal, QC, Canada
| | - Carla Said
- School of Medicine, University of Paris Saclay, Paris, France
| | - Philippe Jouvet
- Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Pediatric Critical Care, University of Montreal, Montréal, QC, Canada
| | - Atsushi Kawaguchi
- Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Pediatric Critical Care, University of Montreal, Montréal, QC, Canada
- Department of Intensive Care Medicine, Pediatric Critical Care Medicine, Tokyo Women's Medical University, Tokyo, Japan
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17
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Grossi U, Gallo G, Ortenzi M, Piccino M, Salimian N, Guerrieri M, Sammarco G, Felice C, Santoro GA, Di Saverio S, Di Tanna GL, Zanus G. Changes in hospital admissions and complications of acute appendicitis during the COVID-19 pandemic: A systematic review and meta-analysis. HEALTH SCIENCES REVIEW (OXFORD, ENGLAND) 2022; 3:100021. [PMID: 35287332 PMCID: PMC8906891 DOI: 10.1016/j.hsr.2022.100021] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 02/25/2022] [Indexed: 12/29/2022]
Abstract
Background Acute appendicitis (AA) is one of the most common emergencies in general surgery worldwide. During the pandemic, a significant decrease in the number of accesses to the emergency department for AA has been recorded in different countries. A systematic review of the current literature sought to determine the impact of Coronavirus Disease 2019 (COVID-19) on hospital admissions and complications of AA. Method A systematic search was undertaken to identify repeated cross-sectional studies reporting the management of AA during the COVID-19 pandemic (index period) as compared to the previous year, or at the turn of lockdown (reference period). Data were abstracted on article (country of origin) and patients characteristics (adults, children [i.e. non adults, <18-year-old]), or mixed population) within the two given timeframes, including demographics, number of admissions for AA, number of appendectomies, and complicated appendectomies. Results Of 201 full-text articles assessed for eligibility, 54 studies from 22 world countries were included. In total, 27 (50%) were conducted on adults, 12 (22%) on children, and 15 (28%) on a mixed patients population. The overall rate ratio of admissions for AA between the two periods was 0.94 (95%CI, 0.75-1.17), with significant differences between studies on adults (0.90 [0.74-1.09]), mixed population (0.50 [0.27-0.90]), and children (1.50 [1.01-2.22]). The overall risk ratio of complicated AA was 1.65 (1.32-2.07), ranging from 1.32 in studies on children, to 2.45 in mixed population. Conclusion The pandemic has altered the rate of admissions for AA and appendectomy, with parallel increased incidence of complicated cases in all age groups.
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Affiliation(s)
- Ugo Grossi
- II Surgery Unit, Treviso Regional Hospital, DISCOG, University of Padua, Italy
| | - Gaetano Gallo
- Department of Medical and Surgical Sciences, University of Catanzaro, Catanzaro, Italy
| | - Monica Ortenzi
- Department of General and Emergency Surgery, Polytechnic University of Marche, Ancona, Italy
| | - Marco Piccino
- II Surgery Unit, Treviso Regional Hospital, DISCOG, University of Padua, Italy
| | - Nick Salimian
- II Surgery Unit, Treviso Regional Hospital, DISCOG, University of Padua, Italy
| | - Mario Guerrieri
- Department of General and Emergency Surgery, Polytechnic University of Marche, Ancona, Italy
| | - Giuseppe Sammarco
- Department of Health Sciences, University of Catanzaro, Catanzaro, Italy
| | - Carla Felice
- I Medicine Unit, Treviso Regional Hospital, DIMED, University of Padua, Italy
| | | | - Salomone Di Saverio
- Department of General Surgery, University of Insubria, ASST Sette Laghi, Varese, Italy
| | - Gian Luca Di Tanna
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, NSW, Australia
| | - Giacomo Zanus
- II Surgery Unit, Treviso Regional Hospital, DISCOG, University of Padua, Italy
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18
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Tankel J, Keinan A, Gillis R, Yoresh M, Gillis M, Tarnovsky Y, Riessman P. Exploring the trends of acute appendicitis following recovery or vaccination from COVID-19. J Surg Res 2022; 279:633-638. [PMID: 35926313 PMCID: PMC9234038 DOI: 10.1016/j.jss.2022.06.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 05/06/2022] [Accepted: 06/08/2022] [Indexed: 11/06/2022]
Abstract
Introduction The relationship that vaccination against corona virus disease 19 (COVID-19) or recovery from the acute form of the illness may have with the incidence or severity of acute appendicitis (AA) has not been explored. The aim of this study was to evaluate this relationship. Methods A single centre retrospective study of all consecutive adult patients presenting with AA in the 6 mo after the initiation of a national vaccination program was performed. The presenting characteristics and pathological data of patients who had either been vaccinated against or recovered from COVID-19 were compared with those who had not. In addition, historical data from the equivalent period 12 and 24 mo beforehand was also extracted. The incidence of AA was compared between each of these time-frames. Results Of the 258 patients initially identified, 255 were included in the analysis of which 156 had either been vaccinated and/or recovered from COVID-19 (61.2%) whilst 99 (38.8%) patients had not. When comparing these two groups, there were no significant differences in the presenting characteristics, operative findings or postoperative courses. There was also no significant change in the incidence of AA when comparing the study dates with historical data (median weekly incidence of AA 8.0 versus 8.0 versus 8.0 respectively, P = 0.672). Conclusions Based on the data presented here, we failed to find a relationship between a national vaccination program and both the nature and incidence of AA presenting to a busy urban hospital.
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19
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Cassell K, Zipfel CM, Bansal S, Weinberger DM. Trends in non-COVID-19 hospitalizations prior to and during the COVID-19 pandemic period, United States, 2017 â€" 2021. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2022:2022.04.26.22274301. [PMID: 35547844 PMCID: PMC9094108 DOI: 10.1101/2022.04.26.22274301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
COVID-19 pandemic-related shifts in healthcare utilization, in combination with trends in non-COVID-19 disease transmission and NPI use, had clear impacts on infectious and chronic disease hospitalization rates. Using a national healthcare billing database (C19RDB), we estimated the monthly incidence rate ratio of hospitalizations between March 2020 and June 2021 according to 19 ICD-10 diagnostic chapters and 189 subchapters. The majority of hospitalization causes showed an immediate decline in incidence during March 2020. Hospitalizations for diagnoses such as reproductive neoplasms, hypertension, and diabetes returned to pre-pandemic norms in incidence during late 2020 and early 2021, while others, like those for infectious respiratory disease, never returned to pre-pandemic norms. These results are crucial for contextualizing future research, particularly time series analyses, utilizing surveillance and hospitalization data for non-COVID-19 disease. Our assessment of subchapter level primary hospitalization codes offers new insight into trends among less frequent causes of hospitalization during the COVID-19 pandemic.
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Affiliation(s)
- Kelsie Cassell
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven CT, USA
| | - Casey M Zipfel
- Department of Biology, Georgetown University, Washington DC, USA
| | - Shweta Bansal
- Department of Biology, Georgetown University, Washington DC, USA
| | - Daniel M. Weinberger
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven CT, USA
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20
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Tzortzopoulou AK, Tsolia M, Spyridis N, Giamarelou P, Sfakiotaki R, Passalides A, Zavras N. A New Score for the Diagnosis of Complicated Appendicitis in Children - Complicated Appendicitis Pediatric Score. J Indian Assoc Pediatr Surg 2022; 27:410-418. [PMID: 36238344 PMCID: PMC9552662 DOI: 10.4103/jiaps.jiaps_110_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 08/29/2021] [Accepted: 10/05/2021] [Indexed: 11/09/2022] Open
Abstract
Aim This study aims to construct and validate a new score for diagnosis of complicated appendicitis in children, complicated appendicitis pediatric score (CoAPS), to guide residents' clinical decision-making on choosing the correct patients for immediate surgery, reducing the emergency negative surgeries. Methods This prospective observational study enrolled two cohorts of patients 5-15 years old. Four hundred and seven consecutive patients were enrolled for the derivation cohort. Demographic data, clinical features, and histopathology data were collected. The outcome measure was the histological diagnosis of gangrenous appendicitis with or without perforation. The score was next validated in a separate cohort of 312 consecutive patients who were classified according to their risk of complicated appendicitis. The diagnostic performance of the score and the potential for the risk stratification to select patients for diagnostic imaging, emergency operative management, and reduce emergency negative operation rates were quantified. Results A positive "jumping up" test, vomiting, white blood cell >13.5 × 10^3/ml, lymphocytes <18%, and C-reactive protein >50 mg/dl were independent predictors for complicated appendicitis. The final prediction model exhibited an area under the curve of 0.890 (95% confidence interval: 0.859-0.922). The low-risk group demonstrated high sensitivity (90.4%) for complicated appendicitis, while scores 6 or more were very specific (95%) for the disorder. Describing the potential utility of the score, emergency ultrasound imaging would have been postponed in 14.5% of patients (P = 0.0016), and emergency negative explorations would have been cut by 87%. Conclusion The CoAPS score could guide residents in emergency management of children with complicated appendicitis reducing hospitalizations and urgent surgeries.
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Affiliation(s)
- Adelais K. Tzortzopoulou
- 2nd Department of Pediatric Surgery, “P. & A. Kyriakou” Childrens’ Hospital, Athens, Greece,Medical School, University of Athens, Athens, Greece
| | - Mariza Tsolia
- Medical School, University of Athens, Athens, Greece
| | - Nicolaos Spyridis
- Medical School, University of Athens, Athens, Greece,Address for correspondence: Dr. Nicolaos Zavras, Medical School, National and Kapodistrian University of Athens, Mikras Asias 75, 11527 Athens, Greece. E-mail:
| | | | - Rodanthi Sfakiotaki
- Department of Radiology, Children's Hospital “P. & A. Kyriakou”, Athens, Greece
| | - Alexander Passalides
- 2nd Department of Pediatric Surgery, “P. & A. Kyriakou” Childrens’ Hospital, Athens, Greece
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21
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Bašković M, Čizmić A, Bastić M, Župančić B. The Impact of the COVID-19 Pandemic on the Most Common Diagnoses in Pediatric Surgery: Abdominal Pain, Acute Scrotum, Upper and Lower Extremity Injuries-Tertiary Center Experience. Turk Arch Pediatr 2022; 57. [PMID: 35110077 PMCID: PMC8867514 DOI: 10.5152/turkarchpediatr.2021.21230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The coronavirus disease-19 pandemic has brought new patterns of behavior among patients and their parents. The reorganization of the health care system has reduced the number of elective surgical procedures in Croatia. In our study, we were interested in whether the pandemic has caused a statistically significant decrease in the number of examinations of children in the emergency department according to the most common diagnoses in pediatric surgery and whether there was a decrease in the number of emergency surgeries. MATERIALS AND METHODS We retrospectively analyzed data from the Hospital Information System. The analysis included 15 months of the pre-coronavirus disease-19 period and 15 months of the coronavirus disease-19 period. The primary outcome of the study was to determine the cumulative number of all examinations and then to determine the number of examinations according to the most common diagnoses and, consequently, to determine whether there was a statistically significant decrease. The secondary outcome was to determine the cumulative number of all operations and then to determine the number of the most common emergency operations and, consequently, to see if there was a statistically significant decrease. RESULTS In the 15 months of the pre- coronavirus disease-19 period, a total of 33 646 children were examined in the emergency department, while in the coronavirus disease-19 period, 26 831 were examined (P = .010). Although a decrease was recorded in all categories, a statistically significant decrease was recorded for diagnoses of abdominal pain (P = .007) and lower extremity injuries (P = .014). The total number of operations, due to strict measures and reduction of the elective program, decreased statistically significantly in the coronavirus disease-19 period (P < .0001). The number of most common emergency operations did not decrease statistically significantly. CONCLUSION This study represents the first longer, 15-month experience of a pandemic in the only and largest children's hospital in Croatia. There is no doubt that coronavirus disease-19 had the effect of reducing the number of examinations in the emergency department for all the most common diagnoses, but the number of operations did not change significantly.
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22
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Hannan MJ, Parveen MK, Hoque MM, Chowdhury TK, Hasan MS, Nandy A. Management of Acute Appendicitis in Children During COVID-19 and Perspectives of Pediatric Surgeons From South Asia: Survey Study. JMIR Perioper Med 2021; 4:e26613. [PMID: 34818209 PMCID: PMC8691415 DOI: 10.2196/26613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 04/26/2021] [Accepted: 11/22/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Nonoperative treatment (NOT) of pediatric appendicitis as opposed to surgery elicits great debate and is potentially influenced by physician preferences. Owing to the effects of the COVID-19 pandemic on health care, the practice of NOT has generally increased by necessity and may, in a post-COVID-19 world, change surgeons' perceptions of NOT. OBJECTIVE The aim of this study was to determine whether the use of NOT has increased in South Asia and whether these levels of practice would be sustained after the pandemic subsides. METHODS A survey was conducted among pediatric surgeons regarding their position, institute, and country; the number of appendicitis cases they managed; and their mode of treatment between identical time periods in 2019 and 2020 (April 1 to August 31). The survey also directly posed the question as to whether they would continue with the COVID-19-imposed level of NOT after the effect of the pandemic diminishes. RESULTS A total of 134 responses were collected out of 200 (67.0%). A significant increase in the practice of NOT was observed for the entire cohort, although no effect was observed when grouped by country or institute. When grouped by position, senior physicians increased the practice of NOT the most, while junior physicians reported the least change. The data suggest that only professors would be inclined to maintain the COVID-19-level of NOT practice after the pandemic. CONCLUSIONS Increased practice of NOT during the COVID-19 pandemic was observed in South Asia, particularly by senior surgeons. Only professors appeared inclined to consider maintaining this increased level of practice in the post-COVID-19 world.
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Affiliation(s)
- Md Jafrul Hannan
- Department of Pediatric Surgery, South Point Hospital, Chittagong, Bangladesh
| | | | - Md Mozammel Hoque
- Department of Pediatric Surgery, Chattagram Maa-O-Shishu Hospital Medical College, Chittagong, Bangladesh
| | | | - Md Samiul Hasan
- Department of Pediatric Surgery, Dhaka Shishu Hospital, Dhaka, Bangladesh
| | - Alak Nandy
- Department of Anesthesiology, Chattgram Maa-O-Shishu Hospital Medical College, Chittagong, Bangladesh
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23
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Ergün E, Sözduyar S, Gurbanova A, Serttürk F, Çiftçi E, Özdemir H, Arga G, Konca HK, Çınar G, Akdemir Kalkan İ, Gülten E, Selvi Can Ö, Şen Akova B, Suat Fitöz Ö, Vatansever G, Tekin D, Göllü G, Bingöl-Koloğlu M, Yağmurlu A, Çakmak M, Ateş U. An indirect effect of COVID-19 pandemic: Increased pediatric perforated appendicitis rate due to delayed admission. Turk J Surg 2021; 37:318-323. [PMID: 35677491 PMCID: PMC9130943 DOI: 10.47717/turkjsurg.2021.5277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 10/06/2021] [Indexed: 11/23/2022]
Abstract
Objectives Appendicitis is a common surgical emergency among children. The coronavirus pandemic affected the system of hospitals more than any other field, and great amount of people were concerned about visiting the hospitals for any reason. In this study, it was aimed to evaluate the profile of appendicitis by emphasizing perforated and acute appendicitis in the pandemic period and to compare the rates with previous three years. Material and Methods Charts of the children who underwent laparoscopic appendectomy due to appendicitis between March 11-September 30 between 2017-2020 were retrospectively analyzed in terms of demographic data, duration of symptoms, duration between hospital admission and surgery, radiologic imaging and perioperative outcomes. Results This study includes 467 children who underwent laparoscopic appendectomy. There were 97 procedures in 2020, 111 in 2019, 146 in 2018 and 113 in 2017. Multiple comparison tests revealed that age did not show difference; but onset of symptoms in admission (p= 0.004), hospitalization time before surgery (p <0.001), total hospitalization time (p <0.001) showed statistically significant difference between years. Pairwise comparisons showed that these parameters were increased in 2020 compared to other years. Perforated appendicitis rate was significantly increased in 2020 when compared to previous years. Conclusion Although there is no direct relation between appendicitis and COVID-19 infection in the current knowledge, perforated appendicitis was found to be increased in children during the COVID pandemic. Reason of the higher rate of perforated appendicitis may be multifactorial; however, the pandemic appears to have a role in increased morbidity in children with appendicitis indirectly due to delay of hospital admissions.
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Affiliation(s)
- Ergun Ergün
- Department of Pediatric Surgery, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Sümeyye Sözduyar
- Department of Pediatric Surgery, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Aynur Gurbanova
- Department of Pediatric Surgery, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Fırat Serttürk
- Department of Pediatric Surgery, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Ergin Çiftçi
- Division of Pediatric Infectious Disease, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Halil Özdemir
- Division of Pediatric Infectious Disease, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Gül Arga
- Division of Pediatric Infectious Disease, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Hatice Kübra Konca
- Division of Pediatric Infectious Disease, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Güle Çınar
- Department of Infectious Diseases and Clinical Microbiology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - İrem Akdemir Kalkan
- Department of Infectious Diseases and Clinical Microbiology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Ezgi Gülten
- Department of Infectious Diseases and Clinical Microbiology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Özlem Selvi Can
- Department of Anesthesia and Reanimation, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Birsel Şen Akova
- Division of Pediatric Radiology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Ömer Suat Fitöz
- Division of Pediatric Radiology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Göksel Vatansever
- Division of Pediatric Emergency, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Deniz Tekin
- Division of Pediatric Emergency, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Gülnur Göllü
- Department of Pediatric Surgery, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Meltem Bingöl-Koloğlu
- Department of Pediatric Surgery, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Aydın Yağmurlu
- Department of Pediatric Surgery, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Murat Çakmak
- Department of Pediatric Surgery, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Ufuk Ateş
- Department of Pediatric Surgery, Ankara University Faculty of Medicine, Ankara, Turkey
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24
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The impact of COVID-19 on surgical procedures in Japan: analysis of data from the National Clinical Database. Surg Today 2021; 52:22-35. [PMID: 34783905 PMCID: PMC8592826 DOI: 10.1007/s00595-021-02406-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 10/26/2021] [Indexed: 12/25/2022]
Abstract
Background and purpose The spread of COVID-19 has restricted the delivery of standard medical care to surgical patients dramatically. Surgical triage is performed by considering the type of disease, its severity, the urgency for surgery, and the condition of the patient, in addition to the scale of infectious outbreaks in the region. The purpose of this study was to evaluate the impact of the COVID-19 pandemic on the number of surgical procedures performed and whether the effects were more prominent during certain periods of widespread infection and in the affected regions. Methods We selected 20 of the most common procedures from each surgical field and compared the weekly numbers of each operation performed in 2020 with the respective numbers in 2018 and 2019, as recorded in the National Clinical Database (NCD). The surgical status during the COVID-19 pandemic as well as the relationship between surgical volume and the degree of regional infection were analyzed extensively. Results The rate of decline in surgery was at most 10–15%. Although the numbers of most oncological and cardiovascular procedures decreased in 2020, there was no significant change in the numbers of pancreaticoduodenectomy and aortic replacement procedures performed in the same period. Conclusion The numbers of most surgical procedures decreased in 2020 as a result of the COVID-19 pandemic; however, the precise impact of surgical triage on decrease in detection of disease warrants further investigation. Supplementary Information The online version contains supplementary material available at 10.1007/s00595-021-02406-2.
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25
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Hayatghaibi SE, Trout AT, Dillman JR, Callahan M, Iyer R, Nguyen H, Riedesel E, Ayyala RS. Trends in Pediatric Appendicitis and Imaging Strategies During Covid-19 in the United States. Acad Radiol 2021; 28:1500-1506. [PMID: 34493456 PMCID: PMC8390378 DOI: 10.1016/j.acra.2021.08.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 08/05/2021] [Accepted: 08/08/2021] [Indexed: 02/06/2023]
Abstract
RATIONALE AND OBJECTIVES To determine if, during the first wave of the COVID-19 pandemic, 1) the proportion of complicated appendicitis changed, and 2) if imaging strategies for appendicitis in children changed. MATERIALS AND METHODS Retrospective cross-sectional study using administrative data from the Pediatric Health Information System, inclusive of pediatric patients diagnosed with appendicitis from March to May in 2017, 2018, 2019 and 2020. We compared trends during COVID-19 pandemic (March-May 2020) with corresponding pre-COVID-19 periods in 2017-201.9 Study outcomes were the proportion of complicated appendicitis and trends in imaging for appendicitis explained by patient-level variables. RESULTS The proportion of complicated appendicitis cases increased by 4.4 percentage points, from 46.5% pre-COVID-19 (2017-2019) to 50.9% during COVID-19 (2020), p < 0.001. Mean count of uncomplicated acute appendicitis cases decreased from pre-COVID-19 to the 2020 COVID-19 period (2017: n = 2555; 2018: n = 2679; 2019: n = 2722; 2020: n = 2231). Mean count of complicated appendicitis was unchanged between study periods (2017: n = 2189; 2018: n = 2302, 2019: n = 2442; 2020: n = 2311). Imaging approaches were largely unchanged between study periods; ultrasound was the most utilized modality in both study periods (68.3%, 70.2%; p = 0.033). CONCLUSION During the first wave of the COVID-19 pandemic, the proportion of complicated appendicitis cases increased without an absolute increase in the number of complicated appendicitis cases, but instead a decrease in the number of uncomplicated acute appendicitis diagnoses.
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Affiliation(s)
- Shireen E Hayatghaibi
- Department of Radiology, Texas Children's Hospital, Houston Texas; University of Texas, School of Public Health, Houston, Texas
| | - Andrew T Trout
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Jonathan R Dillman
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Michael Callahan
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ramesh Iyer
- Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington
| | - HaiThuy Nguyen
- Department of Radiology, Texas Children's Hospital, Houston Texas
| | - Erica Riedesel
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia; Division of Pediatric Radiology, Children's Healthcare of Atlanta Division of Pediatric Radiology, Atlanta, Georgia
| | - Rama S Ayyala
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH.
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26
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Mehl SC, Loera JM, Shah SR, Vogel AM, Fallon SC, Glover CD, Monson LA, Enochs JA, Hollier LH, Lopez ME. Favorable postoperative outcomes for children with COVID-19 infection undergoing surgical intervention: Experience at a free-standing children's hospital. J Pediatr Surg 2021; 56:2078-2085. [PMID: 33581882 PMCID: PMC7838581 DOI: 10.1016/j.jpedsurg.2021.01.033] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 01/13/2021] [Accepted: 01/23/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Current literature has shown that adult patients with perioperative Coronavirus Disease-2019 (COVID-19) have increased rates of postoperative morbidity and mortality. We hypothesized that children with COVID-19 have favorable postoperative outcomes compared to the reported adult experience. METHODS We performed a retrospective cohort study for children with a confirmed preoperative COVID-19 diagnosis from April 1st, 2020 to August 15th, 2020 at a free-standing children's hospital. Primary outcomes evaluated were postoperative complications, readmissions, reoperations, and mortality within 30 days of operation. Secondary outcomes included hospital resource utilization, hospital length of stay, and postoperative oxygen support. RESULTS A total of 66 children with preoperative confirmed COVID-19 were evaluated with median age of 9.5 years (interquartile range (IQR) 5-14) with 65% male and 70% Hispanic White. Sixty-five percent of patients had no comorbidities, with abdominal pain identified as the most common preoperative symptom (65%). Twenty-three percent of patients presented with no COVID-19 related symptoms. Eighty-two percent of patients had no preoperative chest imaging and 98% of patients did not receive preoperative oxygen support. General pediatric surgeons performed the majority of procedures (68%) with the most common diagnosis appendicitis (47%). Forty-one percent of patients were discharged the same day as surgery with 9% of patients utilizing postoperative intensive care unit resources and only 5% receiving postoperative invasive mechanical ventilation. Postoperative complications (7%), readmission (6%), and reoperation (6%) were infrequent, with no mortality. CONCLUSION COVID-19+ children requiring surgery have a favorable postoperative course and short-term outcomes compared to the reported adult experience. TYPE OF STUDY Prognosis Study. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Steven C. Mehl
- Department of Surgery, Baylor College of Medicine, Houston, TX, United States,Michael E. DeBakey Department of Surgery, Division of Pediatric Surgery, Baylor College of Medicine, Texas Children's Hospital, 6701 Fannin Street, Suite 1210, Houston, TX 77030, United States
| | - Jackquelin M. Loera
- Department of Surgery, Baylor College of Medicine, Houston, TX, United States
| | - Sohail R. Shah
- Department of Surgery, Baylor College of Medicine, Houston, TX, United States,Michael E. DeBakey Department of Surgery, Division of Pediatric Surgery, Baylor College of Medicine, Texas Children's Hospital, 6701 Fannin Street, Suite 1210, Houston, TX 77030, United States
| | - Adam M. Vogel
- Department of Surgery, Baylor College of Medicine, Houston, TX, United States,Michael E. DeBakey Department of Surgery, Division of Pediatric Surgery, Baylor College of Medicine, Texas Children's Hospital, 6701 Fannin Street, Suite 1210, Houston, TX 77030, United States
| | - Sara C. Fallon
- Department of Surgery, Baylor College of Medicine, Houston, TX, United States,Michael E. DeBakey Department of Surgery, Division of Pediatric Surgery, Baylor College of Medicine, Texas Children's Hospital, 6701 Fannin Street, Suite 1210, Houston, TX 77030, United States
| | - Chris D. Glover
- Department of Pediatric Anesthesiology, Texas Children's Hospital, Houston, TX, United States
| | - Laura A. Monson
- Department of Surgery, Division of Plastic Surgery, Texas Children's Hospital, Houston, TX, United States
| | - Joyce A. Enochs
- Department of Surgery, Perioperative Services, Texas Children's Hospital, Houston, TX, United States
| | - Larry H. Hollier
- Department of Surgery, Division of Plastic Surgery, Texas Children's Hospital, Houston, TX, United States
| | - Monica E. Lopez
- Michael E. DeBakey Department of Surgery, Division of Pediatric Surgery, Baylor College of Medicine, Texas Children's Hospital, 6701 Fannin Street, Suite 1210, Houston, TX 77030, United States,Corresponding author
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27
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Abstract
The COVID-19 pandemic has led to new ethical challenges and exposed or exacerbated others that were already present. Through the lens of pediatric surgery, this article aims to discuss issues that have been impacted by the pandemic including triage of care and allocation of scarce resources, equity and access to care, and a physician's competing responsibilities to their patients, families, and selves.
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Affiliation(s)
- Jason Sulkowski
- Children's Hospital of Richmond at Virginia Commonwealth University, United States
| | - Sophie Mayeux
- NYP-Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, Children's North 216-B, 3959 Broadway, New York, NY 10032, United States,NewYork-Presbyterian Hospital, United States
| | - William Middlesworth
- NYP-Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, Children's North 216-B, 3959 Broadway, New York, NY 10032, United States; NYP-Morgan Stanley Children's Hospital, United States.
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28
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The effect of the Covid-19 outbreak on the management of acute appendicitis: A retrospective comparative cohort study. JOURNAL OF SURGERY AND MEDICINE 2021. [DOI: 10.28982/josam.960850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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29
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Acevedo MJ, Steffey D, Dillon JE, Lee JT, Worhunsky DJ. Concurrent COVID-19 infection in children with acute appendicitis: A report of three cases. Radiol Case Rep 2021; 16:2972-2977. [PMID: 34221211 PMCID: PMC8236335 DOI: 10.1016/j.radcr.2021.06.067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 06/18/2021] [Accepted: 06/21/2021] [Indexed: 12/28/2022] Open
Abstract
Literature describing patients with concomitant COVID-19 infection with acute appendicitis in pediatric patients is growing, and understanding the clinical picture of such patients is relevant in their treatment. We report 3 male children who were surgically treated for acute appendicitis and had concomitant SARS-CoV-2 infection. Our first patient was a 12-year-old male who presented with symptoms indicative of appendicitis but no respiratory symptoms associated with COVID-19 (eg cough, shortness of breath). Laboratory evaluation revealed leukopenia and an elevated C-reactive protein; imaging was consistent with acute appendicitis and an acute pulmonary viral infection. Though he lacked diffuse peritonitis on physical examination or a leukocytosis, he was found to have perforated appendicitis in the operating room. Our second patient was another 12-year-old male whose suspected appendicitis was confirmed via ultrasound and surgery. He tested positive for COVID-19 1 month prior and he continued to test positive for infection on admission without any associated respiratory symptoms. Our third patient was a 13-year-old patient who also presented with symptomatic acute appendicitis without apparent COVID-19 manifestations. These cases provide further examples of pediatric patients with concomitant acute appendicitis and COVID-19 infection, namely an unusual presentation of perforated appendicitis with asymptomatic COVID-19-related pulmonary infection and the more common acute appendicitis with asymptomatic COVID-19 infection.
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Affiliation(s)
- Maximo J Acevedo
- College of Medicine-NKY campus, University of Kentucky, Albright Health Center 300, 100 Grant Drive, Highland Heights, KY 41099, USA
| | - Dylan Steffey
- College of Medicine, University of Kentucky, 800 Rose Street MN 150, Lexington, KY 40506, USA
| | - Johanne E Dillon
- Department of Radiology, Division of Pediatric Radiology, University of Kentucky, Lexington, KY, USA
| | - James T Lee
- Department of Radiology, Divisions of Abdominal and Emergency Radiology, University of Kentucky, Lexington, KY, USA
| | - David J Worhunsky
- Department of Surgery, Division of Pediatric Surgery, University of Kentucky, Lexington, KY, USA
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30
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Changes in the number of intensive care unit beds in US hospitals during the early months of the coronavirus disease 2019 (COVID-19) pandemic. Infect Control Hosp Epidemiol 2021; 43:1477-1481. [PMID: 34078507 PMCID: PMC8314191 DOI: 10.1017/ice.2021.266] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Using data from the National Healthcare Safety Network (NHSN), we assessed changes to intensive care unit (ICU) bed capacity during the early months of the COVID-19 pandemic. Changes in capacity varied by hospital type and size. ICU beds increased by 36%, highlighting the pressure placed on hospitals during the pandemic.
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31
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Balvardi S, Fiore J, Feldman LS, Emil S, Poenaru D. Emergency department utilization by children with general surgical conditions during the COVID-19 pandemic. Br J Surg 2021; 108:e105-e106. [PMID: 33793715 PMCID: PMC7929116 DOI: 10.1093/bjs/znaa096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 10/25/2020] [Indexed: 11/22/2022]
Affiliation(s)
- S Balvardi
- Department of Surgery, McGill University, Montreal, Quebec, Canada.,Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, Quebec, Canada.,Harvey E. Beardmore Division of Pediatric Surgery, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - J Fiore
- Department of Surgery, McGill University, Montreal, Quebec, Canada.,Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, Quebec, Canada
| | - L S Feldman
- Department of Surgery, McGill University, Montreal, Quebec, Canada.,Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, Quebec, Canada
| | - S Emil
- Harvey E. Beardmore Division of Pediatric Surgery, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - D Poenaru
- Harvey E. Beardmore Division of Pediatric Surgery, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
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32
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Schäfer FM, Meyer J, Kellnar S, Warmbrunn J, Schuster T, Simon S, Meyer T, Platzer J, Hubertus J, Seitz ST, Knorr C, Stehr M. Increased Incidence of Perforated Appendicitis in Children During COVID-19 Pandemic in a Bavarian Multi-Center Study. Front Pediatr 2021; 9:683607. [PMID: 34026695 PMCID: PMC8138624 DOI: 10.3389/fped.2021.683607] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 04/12/2021] [Indexed: 12/29/2022] Open
Abstract
Introduction: Since early 2020 the COVID-19 pandemic and statutory preventive reorganization of treatment capacities with cancellation of elective surgery as well as curfew regulations led to vastly decreased utilization of primary health care. Materials and Methods: To assess whether there are negative effects on pediatric acute care in Bavaria during the spring 2020 lockdown a state-wide retrospective multi-center study was performed to analyze the rate of perforated appendicitis during lockdown. Children who have been operated on during the corresponding period in 2018/19 served as control group. Results: Overall, 514 patients (292 boys, 222 girls) were included (2020: 176 patients; 2019: 181 patients; 2018: 157 patients). Median age was 11.2 years. Four hundred thirty-nine patients (85.4%) underwent laparoscopic surgery, 69 (13.4%) open surgery and 1.2% underwent conversion from laparoscopic to open surgery. In 2020 a perforation rate of 27.8% (49/176 patients) was found, in 2018-2019 perforation rate was 20.7% (70/338 patients, p = 0.0359, Cochran-Mantel-Haenszel-Test). Subgroup analysis showed that in younger patients (≤ 11.2 years), in 2020 perforation rate was significantly higher with 37.6% (32/85 patients), while 22.2% (39/176) in 2018/2019 (p = 0.014, Fisher's exact test).In boys perforation rate was significantly higher in 2020 with 35.0% (35/100 patients) compared to 21.4% in 2018-2019 (p = 0.0165, Fisher's exact test). Conclusion: During the period of curfew regulations in Bavaria the rate of perforated appendicitis in childhood increased significantly, especially in younger children and boys. Potentially this has to be attributed to delayed presentation to pediatric surgery care. Because of potential long-term sequelae of perforated appendicitis these adverse effects during curfew have to be taken into account for future political decision making to ensure reasonable patient care and avoid collateral damage in near-future or on-going pandemic situations.
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Affiliation(s)
- Frank-Mattias Schäfer
- Department of Pediatric Surgery and Pediatric Urology, Cnopfsche Kinderklinik, Nuremberg, Germany
| | - Johannes Meyer
- Department of Pediatric Surgery and Pediatric Urology, Cnopfsche Kinderklinik, Nuremberg, Germany
| | - Stephan Kellnar
- Department of Pediatric Surgery, Klinikum Dritter Orden, Munich, Germany
| | - Jakob Warmbrunn
- Department of Pediatric Surgery, Klinikum Schwabing, Technical University Munich, Munich, Germany
| | - Tobias Schuster
- Department of Pediatric Surgery, University Hospital Augsburg, Augsburg, Germany
| | - Stefanie Simon
- Department of Pediatric Surgery and Pediatric Urology, Klinikum Nürnberg, Nuremberg, Germany
| | - Thomas Meyer
- Department of Pediatric Surgery, Pediatric Urology and Pediatric Trauma, Hospital for General, Visceral, Vascular and Pediatric Surgery, University Hospital Würzburg, Würzburg, Germany
| | - Julia Platzer
- Center for Pediatric and Adolescent Medicine, Children's Hospital St. Marien gGmbH, Landshut, Germany
| | - Jochen Hubertus
- Department of Pediatric Surgery, Dr. von Hauner Children's Hospital, University Hospital Munich, Munich, Germany
| | - Sigurd T. Seitz
- Department of Pediatric Surgery, University Hospital, Friedrich-Alexander-Universität (FAU) Erlangen, Erlangen, Germany
| | - Christian Knorr
- Department of Pediatric Surgery and Pediatric Orthopedics, Barmherzige Brüder Hospital – St. Hedwig Regensburg, Regensburg, Germany
| | - Maximilian Stehr
- Department of Pediatric Surgery and Pediatric Urology, Cnopfsche Kinderklinik, Nuremberg, Germany
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Farooq MAA, Kabir SMH, Chowdhury TK, Sadia A, Alam MA, Farhad T. Changes in children's surgical services during the COVID-19 pandemic at a tertiary-level government hospital in a lower middle-income country. BMJ Paediatr Open 2021; 5:e001066. [PMID: 34192202 PMCID: PMC8015790 DOI: 10.1136/bmjpo-2021-001066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 02/27/2021] [Accepted: 03/20/2021] [Indexed: 11/04/2022] Open
Abstract
Objective The aim of this study was to quantify the changes that occurred in the surgical services of children during the COVID-19 pandemic from the perspective of a low/middle-income country. Design A case-control study was conducted at a large referral centre in Bangladesh among patients aged ≤12 years. Comparisons were made between cases admitted during a period of 'April to September 2020' (Pandemic period) and controls during a similar period in 2019 (Reference period). The number of admissions and outpatient department (OPD) attendances, age and sex distribution, diagnosis, number and types of surgeries performed (elective vs emergency), variations in treatment of acute appendicitis, types of anaesthesia and mortality were compared. Results Admissions were only 41% of previous year (635 vs 1549), and OPD attendances were only 28% of previous year (603 vs 2152). Admission of children reduced by 65.8%, but neonatal admission reduced only by 7.6%. The median age of the admitted patients was significantly lower during the pandemic period (3 vs 4 years, p<0.01). Acute appendicitis (151, 9.8%) and trauma (61, 9.6%), respectively, were the the most common causes of admission during the reference and the pandemic period. Elective surgeries were only 17% and emergency surgeries were 64% of previous year (p<0.01). Appendectomy (88, 9.1%) and laparotomy (77, 17.6%), respectively, were the most common surgeries performed during the reference and the pandemic period. Conservative treatment of acute appendicitis was more during the pandemic period (47.5% vs 28.5%, p=0.01), but patients who underwent appendectomies had more complicated appendicitis (63.3% vs 42.1%, p=0.01). In all, 90.4% of surgeries were performed by resident doctors. There were no COVID-19- related deaths. Conclusion Trauma became the most common cause of admission during the pandemic, and neonatal surgical conditions remained almost unchanged with high mortality rates. Elective procedures and laparoscopy remained low and resident doctors played a major role in providing surgical services.
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Affiliation(s)
| | - S M Humayun Kabir
- Director, Chattogram Medical College Hospital, Chattogram, Bangladesh
| | | | - Ayesha Sadia
- Department of Paediatric Surgery, Chittagong Medical College, Chattogram, Bangladesh
| | - Md. Afruzul Alam
- Department of Paediatric Surgery, Chittagong Medical College, Chattogram, Bangladesh
| | - Tanzil Farhad
- Department of Paediatric Surgery, Chittagong Medical College, Chattogram, Bangladesh
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Kvasnovsky CL, Shi Y, Rich B, Glick RD, Soffer SZ, Lipskar AM, Dolgin S, Bagrodia N, Hong A, Prince JM, James DE, Sathya C. Reply to letter to the editor regarding New York's COVID-19 shelter-in-place and acute appendicitis in children. J Pediatr Surg 2021; 56:637. [PMID: 33213852 PMCID: PMC7571446 DOI: 10.1016/j.jpedsurg.2020.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 10/08/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Charlotte L Kvasnovsky
- Cohen Children's Medical Center, Division of Pediatric Surgery, 269-01 76th Avenue, New Hyde Park 11040, United States.
| | - Yan Shi
- Cohen Children's Medical Center, Division of Pediatric Surgery, 269-01 76th Avenue, New Hyde Park 11040, United States
| | - Barrie Rich
- Cohen Children's Medical Center, Division of Pediatric Surgery, 269-01 76th Avenue, New Hyde Park 11040, United States
| | - Richard D Glick
- Cohen Children's Medical Center, Division of Pediatric Surgery, 269-01 76th Avenue, New Hyde Park 11040, United States
| | - Samuel Z Soffer
- Cohen Children's Medical Center, Division of Pediatric Surgery, 269-01 76th Avenue, New Hyde Park 11040, United States
| | - Aaron M Lipskar
- Cohen Children's Medical Center, Division of Pediatric Surgery, 269-01 76th Avenue, New Hyde Park 11040, United States
| | - Stephen Dolgin
- Cohen Children's Medical Center, Division of Pediatric Surgery, 269-01 76th Avenue, New Hyde Park 11040, United States
| | - Naina Bagrodia
- Cohen Children's Medical Center, Division of Pediatric Surgery, 269-01 76th Avenue, New Hyde Park 11040, United States
| | - Andrew Hong
- Cohen Children's Medical Center, Division of Pediatric Surgery, 269-01 76th Avenue, New Hyde Park 11040, United States
| | - Jose M Prince
- Cohen Children's Medical Center, Division of Pediatric Surgery, 269-01 76th Avenue, New Hyde Park 11040, United States
| | - Douglas E James
- Cohen Children's Medical Center, Division of Pediatric Surgery, 269-01 76th Avenue, New Hyde Park 11040, United States
| | - Chethan Sathya
- Cohen Children's Medical Center, Division of Pediatric Surgery, 269-01 76th Avenue, New Hyde Park 11040, United States
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Hassoun A, Kadenhe-Chiweshe A, Sharma M. New York's COVID-19 shelter-in-place and acute appendicitis inchildren. J Pediatr Surg 2021; 56:635-636. [PMID: 32981660 PMCID: PMC7831861 DOI: 10.1016/j.jpedsurg.2020.08.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 08/10/2020] [Indexed: 01/31/2023]
Affiliation(s)
- Ameer Hassoun
- New York-Presbyterian Queens Hospital, Department of Emergency Medicine, Division of Pediatric Emergency Medicine, Flushing, Queens, NY, USA.
| | - Angela Kadenhe-Chiweshe
- NewYork-Presbyterian Queens Hospital, Department of Surgery, Division of Pediatric Surgery, Flushing, Queens, NY, USA
| | - Manish Sharma
- New York-Presbyterian Queens Hospital, Department of Emergency Medicine, Division of Pediatric Emergency Medicine, Flushing, Queens, NY, USA
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Kün-Darbois JD, Kahn A, Khonsari RH, Gueutier A, Baldini N, Corre P, Bertin H, Provost M, Lesclous P, Ansidei CM, Majoufre C, Louvrier A, Meyer C, Ammari H, Rougeot A, Moret A, Poisbleau D, Nicot R, Marti-Flich L, Ferri J, Lutz JC, Prevost R, Kimakhe J, Poulet V, Lauwers F, Veyssière A, Bénateau H, Pham Dang N, Barthelemy I, Foletti JM, Chossegros C, Queiros C, Laure B, Paré A, de Boutray M. Significant decrease of facial cellulitis admissions during COVID-19 lockdown in France: A multicentric comparative study. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2021; 123:16-21. [PMID: 33596475 DOI: 10.1016/j.jormas.2021.02.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 02/11/2021] [Indexed: 01/01/2023]
Abstract
During the 2020 coronavirus pandemic, a lockdown was imposed in France during the first wave. An apparent decrease in incidence of cellulitis of odontogenic origin was noticed then. This study aimed to compare the incidence of cellulitis during this extraordinary period with the same period in 2018 and 2019, based on retrospective multicentric data. All maxillofacial surgery departments in French public hospitals were contacted. Responders were asked to include all patients admitted for the surgical drainage of a head and neck abscess of odontogenic origin during the first 2020 lockdown period, and in a similar time frame in 2018 and 2019 (control group), based on screening the French diagnostic and therapeutic classification of medical acts. We report a 44% significant nationwide decrease in the incidence of admissions for cellulitis. There were 187 patients in 2020 for 334 and 333 patients in 2018/2019 respectively. The reasons to explain this finding are hypothetical (organizational reasons leading to earlier management, patients' fear to seek for medical management, usual excess in surgical indications or concomitant decrease of non-steroidal anti-inflammatory drugs delivery). Whatever the explanation, it would be of great interest to find it out in order to improve the prevention of cellulitis.
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Affiliation(s)
- J D Kün-Darbois
- Department of Oral and Maxillo-facial surgery, Angers University Hospital, Angers, France.
| | - A Kahn
- Department of Oral and Maxillo-facial surgery, Angers University Hospital, Angers, France
| | - R H Khonsari
- Department of Maxillo-facial and Plastic surgery, Necker-Enfants Malades University Hospital, Paris, France
| | - A Gueutier
- Department of Oral and Maxillo-facial surgery, Angers University Hospital, Angers, France
| | - N Baldini
- Department of Oral and Maxillo-facial surgery, Angers University Hospital, Angers, France
| | - P Corre
- Department of Oral and Maxillo-facial surgery, Nantes University Hospital, Nantes, France
| | - H Bertin
- Department of Oral and Maxillo-facial surgery, Nantes University Hospital, Nantes, France
| | - M Provost
- Department of Oral and Maxillo-facial surgery, Angers University Hospital, Angers, France; Department of Oral surgery, Centre de soins dentaires, Nantes University Hospital, Nantes, France
| | - P Lesclous
- Department of Oral surgery, Centre de soins dentaires, Nantes University Hospital, Nantes, France
| | - C M Ansidei
- Department of Maxillo-facial surgery, Bordeaux University Hospital, Bordeaux, France
| | - C Majoufre
- Department of Maxillo-facial surgery, Bordeaux University Hospital, Bordeaux, France
| | - A Louvrier
- Department of Maxillo-facial surgery, Besançon University Hospital, Besançon, France
| | - C Meyer
- Department of Maxillo-facial surgery, Besançon University Hospital, Besançon, France
| | - H Ammari
- Department of Maxillo-facial surgery, Félix Guyon Hospital, La Réunion University Hospital, Saint-Denis, France
| | - A Rougeot
- Department of Maxillo-facial surgery, Félix Guyon Hospital, La Réunion University Hospital, Saint-Denis, France
| | - A Moret
- Department of Maxillo-facial surgery and Stomatology, Aix Hospital Centre, Aix-En-Provence, France
| | - D Poisbleau
- Department of Maxillo-facial surgery and Plastic surgery, Grenobles University Hospital, Grenoble, France
| | - R Nicot
- Department of Oral and Maxillo-facial surgery, Lille University Hospital, Lille, France
| | - L Marti-Flich
- Department of Oral and Maxillo-facial surgery, Angers University Hospital, Angers, France; Department of Oral and Maxillo-facial surgery, Lille University Hospital, Lille, France
| | - J Ferri
- Department of Oral and Maxillo-facial surgery, Lille University Hospital, Lille, France
| | - J C Lutz
- Department of Maxillo-facial surgery and Stomatology, Strasbourg University Hospital, Strasbourg, France
| | - R Prevost
- Department of Maxillo-facial surgery, La Rochelle, Ré, Aunis Hospital, La Rochelle, France
| | - J Kimakhe
- Department of Maxillo-facial surgery and Stomatology, Vendée Hospital Centre, La Roche Sur Yon, France
| | - V Poulet
- Department of Maxillo-facial surgery, Purpan University Hospital, Toulouse, France
| | - F Lauwers
- Department of Maxillo-facial surgery, Purpan University Hospital, Toulouse, France
| | - A Veyssière
- Department of Maxillo-facial and Plastic surgery, Caen University Hospital, Caen, France
| | - H Bénateau
- Department of Maxillo-facial and Plastic surgery, Caen University Hospital, Caen, France
| | - N Pham Dang
- Department of Maxillo-facial and Plastic surgery, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - I Barthelemy
- Department of Maxillo-facial and Plastic surgery, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - J M Foletti
- Department of Maxillo-facial surgery, Marseille University Hospital, Marseille, France
| | - C Chossegros
- Department of Maxillo-facial surgery, Marseille University Hospital, Marseille, France
| | - C Queiros
- Department of Maxillo-facial and Plastic surgery, Tours University Hospital, Tours, France
| | - B Laure
- Department of Maxillo-facial and Plastic surgery, Tours University Hospital, Tours, France
| | - A Paré
- Department of Maxillo-facial and Plastic surgery, Tours University Hospital, Tours, France
| | - M de Boutray
- Department of Maxillo-facial surgery, Gui de Chauliac University Hospital Centre, Montpellier University, Montpellier, France
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Wang AW, Prieto J, Ikeda DS, Lewis PR, Benzer EM, Van Gent JM. Perforated Appendicitis: An Unintended Consequence During the Coronavirus-19 Pandemic. Mil Med 2021; 186:e94-e97. [PMID: 33275655 PMCID: PMC7798865 DOI: 10.1093/milmed/usaa527] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 11/10/2020] [Accepted: 11/23/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has had major clinical impact across the globe. Delayed presentation for medical emergencies has been noted by the medical community. There has been limited reporting on the impact for the care for emergent surgical conditions. We sought to describe the effect of the global pandemic on the presentation and outcomes for the most common urgent general surgery disease process, acute appendicitis. METHODS We performed a retrospective review of patients admitted to the United States Naval Hospital Okinawa during the COVID-19 pandemic, from January 2020 to May 2020 (COVID cohort), and compared them to a historical cohort (pre-COVID cohort) over the prior 2 years. Demographics, clinical presentation data, and interventions were collected. RESULTS Of the 80 patients with appendicitis, 20% presented perforated. Most patients were male (71%), presented with 1 day of symptoms and had a length of stay of 1 to 2 days. Comparing groups, 13% of the pre-COVID group vs. 31% of the COVID cohort presented perforated (P = .04), with a symptom duration of 1.6 vs. 2.7 days before presentation (P = .075), respectively. CONCLUSIONS The COVID-19 pandemic and the global systematic response has impacted unrelated medical and surgical conditions. At our overseas military hospital with minimal disease burden, we observed a delay in presentation for acute appendicitis with a higher incidence of perforation. Patients should be empowered to continue to seek care for urgent and emergent medical and surgical conditions so that they are not harmed by fear of COVID-19 rather than by COVID-19 itself.
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Affiliation(s)
- Andrew W Wang
- Departmet of Surgery, United States Naval Hospital Okinawa, Okinawa, Japan, 96362
| | - James Prieto
- Department of Surgery, Naval Medical Center San Diego, San Diego, CA 92134, USA
| | - Daniel S Ikeda
- Departmet of Surgery, United States Naval Hospital Okinawa, Okinawa, Japan, 96362
| | - Paul R Lewis
- Departmet of Surgery, United States Naval Hospital Okinawa, Okinawa, Japan, 96362
| | - Emily M Benzer
- Departmet of Surgery, United States Naval Hospital Okinawa, Okinawa, Japan, 96362
| | - Jan-Michael Van Gent
- Departmet of Surgery, United States Naval Hospital Okinawa, Okinawa, Japan, 96362
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Levene R, Fein DM, Silver EJ, Joels JR, Khine H. The ongoing impact of COVID-19 on asthma and pediatric emergency health-seeking behavior in the Bronx, an epicenter. Am J Emerg Med 2021; 43:109-114. [PMID: 33550101 PMCID: PMC7843065 DOI: 10.1016/j.ajem.2021.01.072] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 01/22/2021] [Accepted: 01/25/2021] [Indexed: 12/24/2022] Open
Abstract
Background The Bronx has the highest prevalence of asthma in the United States (US), and was also an early COVID-19 epicenter, making it a unique study location. Worldwide reports describe significant declines in pediatric emergency department (PED) visits during COVID-19. The ongoing impact of COVID-19 on all PED presentations, including asthma, at an early epicenter has not been studied beyond the pandemic peak and into the early phases of state re-opening. Objectives To compare PED health-seeking behaviors and clinical characteristics during the 2020 pandemic and subsequent initial New York State (NYS) phased re-opening to the same period in 2019. Methods Retrospective chart review of children <21 years utilizing the PED at a high-volume quaternary children's hospital in The Bronx, NY from March 15th 2020 – July 6th 2020 (pandemic cohort) and the same interval in 2019 (comparison cohort). Visits were assigned to pre-determined diagnostic categories. Demographic and clinical data were compared. Results 19,981 visits were included. Visits declined by 66% during 2020. Proportions of asthma visits (2% vs. 7%, p < 0.0001) and minor medical problems (61% vs. 67%, p < 0.0001) had significant declines in the pandemic cohort, while major medical problems (13% vs. 8%, p < 0.0001), appendicitis (1% vs. 0.4%, p < 0.0001) and other surgical complaints (1% vs. 0.5%, p < 0.0001) had proportional increases in the pandemic cohort. No significant proportional changes were noted among psychosocial and trauma groups between the two cohorts. Conclusion The pandemic cohort experienced a substantial decrease in PED volume, but an increase in acuity and admission rates, which was sustained through the NYS phase-II re-opening. Despite being located in an asthma hub, the incidence of asthma-related PED visits declined appreciably in the pandemic cohort. Future studies examining the effects of indoor allergens in isolation on pediatric asthma are warranted.
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Affiliation(s)
- Rachel Levene
- Division of Pediatric Emergency Medicine, The Children's Hospital at Montefiore, Bronx, NY, United States of America.
| | - Daniel M Fein
- Division of Pediatric Emergency Medicine, The Children's Hospital at Montefiore, Bronx, NY, United States of America
| | - Ellen J Silver
- Division of Academic General Pediatrics, Albert Einstein College of Medicine, Bronx, NY, United States of America
| | - Joanna R Joels
- Department of Pediatrics, The Children's Hospital at Montefiore, Bronx, NY, United States of America
| | - Hnin Khine
- Division of Pediatric Emergency Medicine, The Children's Hospital at Montefiore, Bronx, NY, United States of America
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Ingram MCE, Mehl S, Rentea RM, Lopez ME, Raval MV, Newton C, Berman L. Sharing strategies for safe delivery of surgical care for children in the COVID-19 Era. J Pediatr Surg 2021; 56:196-198. [PMID: 33248680 PMCID: PMC7661910 DOI: 10.1016/j.jpedsurg.2020.11.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 11/10/2020] [Indexed: 12/20/2022]
Affiliation(s)
- Martha-Conley E. Ingram
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA,Corresponding author
| | - Steven Mehl
- Division of Pediatric Surgery, Department of Surgery, Baylor College of Medicine, Texas Children's Hospital, Houston TX, USA
| | - Rebecca M. Rentea
- Division of Pediatric Surgery, Department of Surgery, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA
| | - Monica E. Lopez
- Division of Pediatric Surgery, Department of Surgery, Baylor College of Medicine, Texas Children's Hospital, Houston TX, USA
| | - Mehul V. Raval
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Christopher Newton
- Division of Pediatric Surgery, Department of Surgery, UCSF East Bay, Oakland, CA, USA
| | - Loren Berman
- Division of Pediatric Surgery, Department of Surgery, Sidney Kimmel Medical College at Thomas Jefferson University Hospital, Nemours Al duPont Hospital for Children, Wilmington, DE, USA
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Meyer JS, Robinson G, Moonah S, Levin D, McGahren E, Herring K, Poulter M, Waggoner-Fountain L, Shirley DA. Acute appendicitis in four children with SARS-CoV-2 infection. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2021; 64:101734. [PMID: 33262930 PMCID: PMC7690274 DOI: 10.1016/j.epsc.2020.101734] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/20/2020] [Accepted: 11/22/2020] [Indexed: 02/07/2023] Open
Abstract
We describe 4 children (11-17 years in age) at our institution with acute appendicitis in the setting of SARS-CoV-2 infection, suggesting a possible association. Providers should consider testing for this infection in patients with severe gastrointestinal symptoms, in order to take appropriate transmission based precautions, until more is understood.
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Key Words
- ACE2, angiotensin-converting enzyme 2
- Appendicitis
- COVID-19
- COVID-19, novel coronavirus disease 2019
- CT, computed tomography
- ED, emergency department
- HEPA, high-efficiency particulate air
- IV, intravenous
- MIS-C, multisystem inflammatory syndrome in children
- NP, nasopharyngeal
- PCR, polymerase-chain-reaction
- SARS-CoV-2
- SARS-CoV-2, severe acute respiratory syndrome coronavirus 2
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Affiliation(s)
- Jessica S Meyer
- Pediatric Hospital Medicine, Department of Pediatrics, University of Virginia, Charlottesville, VA, USA
| | - Grant Robinson
- Department of Pediatrics, University of Virginia, Charlottesville, VA, USA
| | - Shannon Moonah
- Division of Infectious Diseases & International Health, Department of Medicine, University of Virginia Health System, Charlottesville, VA, USA
| | - Daniel Levin
- Division of Pediatric Surgery, Department of Pediatrics, University of Virginia, Charlottesville, VA, USA
| | - Eugene McGahren
- Division of Pediatric Surgery, Department of Pediatrics, University of Virginia, Charlottesville, VA, USA
| | - Katye Herring
- Division of Pediatric Hematology & Oncology, Department of Pediatrics, University of Virginia, Charlottesville, VA, USA
| | - Melinda Poulter
- Division of Laboratory Medicine/ Clinical Laboratories, Department of Pathology, University of Virginia, Charlottesville, VA, USA
| | - Linda Waggoner-Fountain
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Virginia, Charlottesville, VA, USA
| | - Debbie-Ann Shirley
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Virginia, Charlottesville, VA, USA
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Rate of Application and Outcome of Non-operative Management of Acute Appendicitis in the Setting of COVID-19: Systematic Review and Meta-analysis. J Gastrointest Surg 2021; 25:1905-1915. [PMID: 33772399 PMCID: PMC7997536 DOI: 10.1007/s11605-021-04988-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 03/15/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Non-operative management (NOM) of acute appendicitis has been assessed in several studies before COVID-19 pandemic. This systematic review aimed to assess the extent of adoption, efficacy, and safety of NOM of acute appendicitis in the setting of COVID-19. METHODS This was a PRISMA-compliant systematic review of the literature. Electronic databases and Google Scholar were queried for studies that applied NOM of acute appendicitis during COVID-19. The main outcome measures were the rates of NOM application during the pandemic as compared to the pre-pandemic period, failure and complication rates of NOM. Failure was defined as the need for appendectomy during NOM and complications included development of appendicular mass or abscess. RESULTS Fourteen studies (2140 patients) were included. The male to female ratio was 1.44:1 and median age was 34. Nine hundred fifty-nine (44.8%) patients had a trial of NOM. The weighted mean rate of NOM application was 50.1% (95%CI: 29.8-70.5%). The application of NOM during the pandemic was significantly more likely than its application before COVID-19 (OR = 6.7, p < 0.001). The weight mean failure rate of NOM was 16.4% (95%CI: 9.4-23.4). NOM failure was more likely in children and patients with complicated appendicitis. The weighted mean complication rate after NOM was 4.5% (95%CI: 1.4-7.7). NOM had significantly lower odds for complications than appendectomy (OR = 0.36, p = 0.03). There was no mortality after application of NOM. CONCLUSION NOM of acute appendicitis in the setting of COVID-19 may be a safe, short-term alternative to surgery with acceptably low failure and complication rates.
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Horst KK, Kolbe AB, McDonald JS, Froemming AT, Parvinian A, Klinkner DB, Binkovitz LA. Imaging pediatric acute appendicitis during the coronavirus disease 2019 (COVID-19) pandemic: collateral damage is variable. Pediatr Radiol 2021; 51:1991-1999. [PMID: 34402958 PMCID: PMC8367768 DOI: 10.1007/s00247-021-05128-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 05/17/2021] [Accepted: 06/10/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Since coronavirus disease 2019 (COVID-19) was declared a worldwide pandemic in March 2020, many authors have noted the collateral damage on non-COVID-19-related illnesses. These indirect effects of the pandemic have resulted in people presenting later and with more severe stages of disease, even if their diagnoses are not directly related to SARS-CoV-2, the virus that causes COVID-19. OBJECTIVE We studied these indirect effects of COVID-19 on the imaging workup and outcomes for pediatric patients at our center who had acute appendicitis during the pandemic. MATERIALS AND METHODS We performed a retrospective review of cases in children ≤18 years who were evaluated for acute appendicitis during the same period, March 1 to May 31, in both 2019 and 2020. We compared demographic and clinical data as well as surgical and pathological findings, and we graded imaging findings according to severity. Differences in patient outcomes were assessed using the Wilcoxon rank sum test and the Pearson chi-square test. RESULTS The total number of pediatric patients evaluated with imaging for acute appendicitis dropped by 43% between 2019 and 2020 (298 vs. 169), but the total number of children treated remained similar (59 vs. 51). There was proportionate use of US and CT in each timeframe but a higher percentage of positive imaging findings in 2020 (50/169, 29.6% vs. 56/298, 18.7% in 2019, P=0.04). There were more imaging examinations with features of complicated appendicitis among positive cases (9/51, 18% vs. 5/59, 8% in 2019, P=0.08) and more pathologically proven perforated cases during the pandemic (14/51, 27% vs. 6/59, 10% in 2019, P=0.11), although these results did not reach statistical significance. There were no changes in surgical management, vital signs, laboratory values, length of stay or complication rates. CONCLUSION There was a large drop in the number of pediatric patients imaged for acute appendicitis during the acute phase of the COVID-19 pandemic despite similar numbers of patients treated. The utilization trends of US vs. CT remained stable between time periods. The differences in imaging findings and perforation rates were less pronounced compared to other published studies.
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Affiliation(s)
- Kelly K. Horst
- grid.66875.3a0000 0004 0459 167XDepartment of Radiology, Mayo Clinic, 200 1st St. SW, Rochester, MN 55905 USA
| | - Amy B. Kolbe
- grid.66875.3a0000 0004 0459 167XDepartment of Radiology, Mayo Clinic, 200 1st St. SW, Rochester, MN 55905 USA
| | - Jennifer S. McDonald
- grid.66875.3a0000 0004 0459 167XDepartment of Radiology, Mayo Clinic, 200 1st St. SW, Rochester, MN 55905 USA
| | - Adam T. Froemming
- grid.66875.3a0000 0004 0459 167XDepartment of Radiology, Mayo Clinic, 200 1st St. SW, Rochester, MN 55905 USA
| | - Ahmad Parvinian
- grid.66875.3a0000 0004 0459 167XDepartment of Radiology, Mayo Clinic, 200 1st St. SW, Rochester, MN 55905 USA
| | - Denise B. Klinkner
- grid.66875.3a0000 0004 0459 167XDepartment of Pediatric Surgery, Mayo Clinic, Rochester, MN USA
| | - Larry A. Binkovitz
- grid.66875.3a0000 0004 0459 167XDepartment of Radiology, Mayo Clinic, 200 1st St. SW, Rochester, MN 55905 USA
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Zvizdic Z, Vranic S. Decreased number of acute appendicitis cases in pediatric population during the COVID-19 pandemic: Any link? J Pediatr Surg 2021; 56:199-200. [PMID: 32943199 PMCID: PMC7441018 DOI: 10.1016/j.jpedsurg.2020.08.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 08/12/2020] [Indexed: 12/25/2022]
Affiliation(s)
- Zlatan Zvizdic
- Department of Pediatric Surgery, Clinical Center, University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Semir Vranic
- College of Medicine, QU Health, Qatar University, Doha, Qatar.
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Maneck M, Günster C, Meyer HJ, Heidecke CD, Rolle U. Influence of COVID-19 confinement measures on appendectomies in Germany-a claims data analysis of 9797 patients. Langenbecks Arch Surg 2020; 406:385-391. [PMID: 33277682 PMCID: PMC7717103 DOI: 10.1007/s00423-020-02041-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 11/17/2020] [Indexed: 11/28/2022]
Abstract
Purpose COVID-19 pandemic had multiple influences on the social, industrial, and medical situation in all affected countries. Measures of obligatory medical confinement were suspensions of scheduled non-emergent surgical procedures and outpatients’ clinics as well as overall access restrictions to hospitals and medical practices. The aim of this retrospective study was to assess if the obligatory confinement (lockdown) had an effect on the number of appendectomies (during and after the period of lockdown). Methods This retrospective study was based on anonymized nationwide administrative claims data of the German Local General Sickness Fund (AOK). Patients admitted for diseases of the appendix (ICD-10: K35-K38) or abdominal and pelvic pain (ICD-10: R10) who underwent an appendectomy (OPS: 5-470) were included. The study period included 6 weeks of German lockdown (16 March–26 April 2020) as well as 6 weeks before (03 February–15 March 2020) and after (27 April–07 June 2020). These periods were compared to the respective one in 2018 and 2019. Results The overall number of appendectomies was significantly reduced during the lockdown time in 2020 compared to that in 2018 and 2019. This decrease affects only appendectomies due to acute simple (ICD-10: K35.30, K35.8) and non-acute appendicitis (ICD-10: K36-K38, R10). Numbers for appendectomies in acute complex appendicitis remained unchanged. Female patients and in the age group 1–18 years showed the strongest decrease in number of cases. Conclusion The lockdown in Germany resulted in a decreased number of appendectomies. This affected mainly appendectomies in simple acute and non-acute appendicitis, but not complicated acute appendicitis. The study gives no evidence that the confinement measures resulted in a deterioration of medical care for appendicitis.
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Affiliation(s)
| | | | | | - Claus-Dieter Heidecke
- Department of General, Visceral, Thoracic and Vascular Surgery, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Udo Rolle
- Goethe-University Frankfurt, University Hospital, Department of Paediatric Surgery and Paediatric Urology, Frankfurt, Germany.
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Acute appendicitis during SARS-CoV-2: A brief communication of patients and changes in clinical practice from a single institute in Pakistan. J Pediatr Surg 2020; 55:2844-2845. [PMID: 32891410 PMCID: PMC7403100 DOI: 10.1016/j.jpedsurg.2020.07.033] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 07/17/2020] [Indexed: 01/25/2023]
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Montalva L, Haffreingue A, Ali L, Clariot S, Julien-Marsollier F, Ghoneimi AE, Peycelon M, Bonnard A. 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; 36:1397-1405. [PMID: 33070203 PMCID: PMC7568762 DOI: 10.1007/s00383-020-04759-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/06/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE To evaluate the impact of the COVID-19 pandemic-related lockdown on management and outcomes of children with acute appendicitis. METHODS A retrospective cohort study was conducted, including children treated for acute appendicitis (January 20th-May 11th, 2020). The data regarding the severity of appendicitis and outcome were collected and compared for two time periods, before and after the nationwide lockdown (March 17th, 2020). RESULTS The number of cases of acute appendicitis increased by 77% during the lockdown (n = 39 vs. n = 69, p = 0.03). During the lockdown, children treated for appendicitis were older (11.1 vs. 8.9 years, p = 0.003), and were more likely to live more than 5 km away from our institution (77% vs. 52%, p = 0.017). Less children had previously consulted a general practitioner (15% vs. 33%, p = 0.028), whereas more children were transferred from other hospitals (52% vs. 31%, p = 0.043). There was no difference in terms of length of hospital stay, rate of postoperative intra-abdominal abscess, ER visits, and readmissions between both periods. Three children (4%) were diagnosed with COVID-19 and appendicitis. CONCLUSIONS Despite an increase in the number of children with appendicitis managed at our hospital during the COVID-19-related lockdown, management, and outcome remained similar. Although our pediatric center was strongly affected by this pandemic, maintaining our prior practice strategies for acute appendicitis avoided the occurrence of collateral damage for those children.
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Affiliation(s)
- Louise Montalva
- Department of General Pediatric Surgery and Urology, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), 48 boulevard Sérurier, 75019 Paris, France
| | - Aurore Haffreingue
- Department of General Pediatric Surgery and Urology, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), 48 boulevard Sérurier, 75019 Paris, France
| | - Liza Ali
- Department of General Pediatric Surgery and Urology, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), 48 boulevard Sérurier, 75019 Paris, France
| | - Simon Clariot
- Department of Anesthesia and Intensive Care, Henri-Mondor University Hospital, Assistance Publique Hôpitaux de Paris (AP-HP), Créteil, France
| | - Florence Julien-Marsollier
- Department of Anesthesia and Intensive Care, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Alaa El Ghoneimi
- Department of General Pediatric Surgery and Urology, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), 48 boulevard Sérurier, 75019 Paris, France ,University of Paris, Paris, France
| | - Matthieu Peycelon
- Department of General Pediatric Surgery and Urology, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), 48 boulevard Sérurier, 75019 Paris, France ,University of Paris, Paris, France
| | - Arnaud Bonnard
- Department of General Pediatric Surgery and Urology, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), 48 boulevard Sérurier, 75019 Paris, France ,University of Paris, Paris, France
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