Abstract
Background: The Coronavirus Disease 2019 (COVID-19) pandemic has impacted volume, management strategies and patient outcomes of acute appendicitis. The aim of this systematic review and meta-analysis was to evaluate whether the COVID-19 pandemic resulted in higher incidence of complicated appendicitis in children presenting with acute appendicitis compared to the pre-COVID-19 period. The secondary aim was to investigate the proportion of the patients treated by non-operative management (NOM). Methods: A systematic search of four scientific databases was performed. The search terms used were (coronavirus OR SARS-CoV-2 OR COVID-19 OR novel coronavirus) AND (appendicitis). The inclusion criteria were all patients aged <18 years and diagnosed with acute appendicitis during the COVID-19 and pre-COVID-19 periods. The proportion of children presenting with complicated appendicitis and the proportion of children managed by NOM was compared between the two groups. The Downs and Black scale was used for methodological quality assessment. Results: The present meta-analysis included thirteen studies (twelve retrospective studies and one cross-sectional study). A total of 2782 patients (1239 during the COVID-19 period) were included. A significantly higher incidence of complicated appendicitis (RR = 1.63, 95% CI 1.33–2.01, p < 0.00001) and a significantly higher proportion of children managed via the NOM (RR = 1.95, 95% CI 1.45–2.61, p < 0.00001) was observed in patients during the COVID-19 pandemic when compared to the pre-COVID-19 period. Conclusion: There is a significantly higher incidence of complicated appendicitis in children during the COVID-19 pandemic than in the pre-COVID-19 period. Additionally, a significantly higher proportion of children was managed via the NOM during the pandemic in comparison to the pre-pandemic period.
Highlights
Acute appendicitis is the most common condition in the pediatric population that leads to emergency abdominal surgery [1,2]
Advanced diagnostic imaging is widely available, the initial diagnosis of appendicitis in children can be challenging, with rates of misdiagnosis reaching 100% in children aged two years or younger [3,4,5,6]. This has been attributed to nonspecific presentation and overlap of symptoms with other common childhood conditions such as mesenteric lymphadenitis, gastroenteritis, or Meckel’s diverticulitis. Clinical scores, such as Alvarado, appendicitis inflammatory response score, and pediatric appendicitis score have been developed to aid the diagnosis of acute appendicitis in children [3,4]
Pooling the data (Figure 3) demonstrated a significantly higher proportion of children managed via the non-operative management (NOM) during the pandemic versus pre-pandemic period (RR = 1.95, 95% CI 1.45–2.61, p
Summary
Acute appendicitis is the most common condition in the pediatric population that leads to emergency abdominal surgery [1,2]. Advanced diagnostic imaging is widely available, the initial diagnosis of appendicitis in children can be challenging, with rates of misdiagnosis reaching 100% in children aged two years or younger [3,4,5,6] This has been attributed to nonspecific presentation and overlap of symptoms with other common childhood conditions such as mesenteric lymphadenitis, gastroenteritis, or Meckel’s diverticulitis. A significantly higher incidence of complicated appendicitis (RR = 1.63, 95% CI 1.33–2.01, p < 0.00001) and a significantly higher proportion of children managed via the NOM (RR = 1.95, 95% CI 1.45–2.61, p < 0.00001) was observed in patients during the COVID-19 pandemic when compared to the pre-COVID-19 period. A significantly higher proportion of children was managed via the NOM during the pandemic in comparison to the pre-pandemic period
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