Eur J Pediatr Surg
DOI: 10.1055/s-0041-1723992
Original Article

Complicated Acute Appendicitis during COVID-19 Pandemic: The Hidden Epidemic in Children

1  Department of Pediatric Surgery, La Paz Children's Hospital, Madrid, Spain
,
1  Department of Pediatric Surgery, La Paz Children's Hospital, Madrid, Spain
,
Miriam Miguel-Ferrero
1  Department of Pediatric Surgery, La Paz Children's Hospital, Madrid, Spain
,
María De Ceano-Vivas
2  Pediatric Emergency Department, La Paz Children's Hospital, Madrid, Spain
,
Cristina Calvo
3  Pediatric Infectious Diseases Department, Fundación IdiPaz. Traslational Research Network in Pediatric Infectious Diseases, Madrid. Spain
,
Leopoldo Martínez
1  Department of Pediatric Surgery, La Paz Children's Hospital, Madrid, Spain
4  Institute for Biomedical Resarch La Paz (IdiPaz), Network for Maternal and Children Health (SAMID), La Paz Children's Hospital, Madrid, Spain
› Author Affiliations
Funding This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Abstract

Introduction Since home confinement for novel coronavirus disease 2019 (COVID-19) pandemic began, pediatric visits to the emergency department (ED) have decreased, including consultation for abdominal pain. Our aim is to investigate the incidence of complicated acute appendicitis (AA; peritonitis or appendicular mass) during confinement for COVID-19 pandemic and to compare it with the previous 5 years.

Materials and Methods A retrospective study was performed in children with AA who underwent surgery between March 9 and April 13 from 2015 to 2020; patients were divided into six groups according to the year of surgery. We analyzed demographic variables, time from onset of symptoms, mean hospital stay, cumulative incidence, and incidence rate of complicated appendicitis.

Results A total of 168 patients were included with no differences in the number of patients, gender, and age between groups. Patients in 2020 (COVID-19 group) presented longer symptom progression time (46.8 hours; p = 0.046), higher rate of complicated appendicitis (48.4%; p = 0.004), longer mean hospital stay (4.9 days; p < 0.001), increased cumulative incidence (8.27 cases per 100,000 children per 0.1 years; p < 0.001), and increased incidence rate of complicated appendicitis (83 cases per 100,000 children; p < 0.001) when compared with other groups.

Conclusion Delayed ED visit of children with AA during home confinement lead to an increased rate of complicated appendicitis. It is crucial to make parents aware of the importance of early diagnosis and treatment of abdominal pain.



Publication History

Received: 29 August 2020

Accepted: 04 January 2021

Publication Date:
22 February 2021 (online)

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