[Impact of COVID-19 on the presentation and course of acute appendicitis in paediatrics]

Abstract

Introduction: Acute appendicitis (AA) is the most frequent urgent surgical pathology in pediatrics. The COVID-19 pandemic has led to a decrease in emergency department (ED) visits, which can lead to a delay in health care and an increase in the severity of the pathologies. The objective is to analyze the rate of complicated AA during the pandemic, compared to the same period of the previous year.

Materials and methods: Retrospective unicenter observational cohort study that included patients under 14 years of age seen in the ED with a diagnosis of AA during the months of March to May 2019 (non-pandemic) and 2020 (pandemic).

Results: 90 patients were included (41 in non-pandemic and 49 in pandemic). No difference was found between the two periods in the time from the clinic onset until the visit to the ED (37h vs 38h, p=0.881), but there was a difference in the time from arrival at the ED until the surgery (7:00h vs 10:30h, p=0.004). The difference was accentuated when comparing the month of March with April-May 2020 (6h vs 12h; p=0.001). No significant differences were observed in the rate of complicated AA in intraoperative diagnosis (35% vs 33%; p=0.870) or anatomopathology (35% vs 48%; p=0.222), nor in the number of postoperative complications, length of hospitalization and readmissions. An increase in the anatomopathological diagnosis of AA with periapendicitis was observed (47% vs 81%; p=0.001) CONCLUSION: During the pandemic, a delay from arrival at the ED until the surgery was observed in children diagnosed with AA. This delay resulted in an increase in the diagnosis of histologically evolved AA, but without an increase in the clinical complications of the disease.

Keywords: Acute appendicitis; Apendicitis aguda; Apendicitis complicada; COVID-19; Complicaciones postoperatorias; Complicated appendicitis; Pandemia; Pandemic; Perforación; Perforation; Postoperative complications.

Figura 1

Número de consultas al Servicio de Urgencias de Pediatría del Hospital Universitario Cruces desglosado por semanas, desde el 1 de marzo al 31 de mayo de 2019 y 2020.

Figura 2

Demora en horas desde el inicio de síntomas hasta la consulta en el Servicio de Urgencias de Pediatría del Hospital Universitario Cruces en los meses de marzo a mayo de 2019, marzo de 2020 y de abril a mayo de 2020.

Figura 3

Demora en horas desde la llegada a Urgencias de Pediatría del Hospital Universitario Cruces hasta la IQ en los meses de marzo a mayo de 2019, marzo de 2020 y de abril a mayo de 2020.