COVID-19 pandemic related improvement in hospital utilization and outcomes for children on home mechanical ventilation

Introduction: The COVID-19 pandemic has disrupted healthcare systems worldwide. In addition to the direct impact of the virus on patient morbidity and mortality, the effect of lockdown strategies on health and healthcare utilization have become apparent. The effect of the pandemic on children on home mechanical ventilation is unknown. We examined the impact of the pandemic on pediatric healthcare utilization in children on home mechanical ventilation. Methods: Between March 11 and December 1, 2020, we conducted a single center, retrospective analysis of 81 children, younger than 18 years old, on home mechanical ventilation who are followed at the UT Physicians High Risk Children's Clinic. Using the same cohort of patients, we compared healthcare utilization during the pandemic in 2020 to the same period in 2019. Results: We observed a massive decline in pediatric healthcare utilization during the pandemic year compared with the previous year. Emergency department total visits decreased by 70% (33 vs 10) (p<0.01). Total number of hospital admissions declined by 38% (52 vs 32) (p=0.03). The mean length of stay (LOS) in hospital admission was 6.7 days in 2019 and 5.3 days in 2020 (p=0.3). Similarly, pediatric intensive care unit (PICU) admissions reduced by 57% (30 vs 13) (P=0.04), and the mean PICU LOS was 7.5 days in 2019 and 6.0 days in 2020 (p=0.5). Mortality did not change during 2020 period (1 vs 0). Conclusions: Our data illustrate a significant improvement in pediatric hospital utilization and outcomes for children on home mechanical ventilation during the COVID-19 pandemic. We speculate that fewer medical office visits, increase in telehealth follow ups, school closures, social distancing, massive mask utilization, and increased hand washing during the pandemic year were protective factors that contributed to a lower hospitalization rate. However, we cannot fully exclude the possibilities of natural history of disease fluctuation, or regression to the mean phenomenon. More studies are needed to confirm the etiology of these findings.

Impact of SARS-CoV-2 pandemic on emergency department activity at the pediatric surgery unit of a third-level hospital

INTRODUCTION: As a result of the emergence of the SARS-CoV-2 respiratory virus in Wuhan in December 2019, the Spanish Government declared the state of emergency with restrictions such as stay-at-home lockdown. The objective of this study was to analyze emergency activity at a referral pediatric surgery unit in its territory and determine whether surgical pathologies had decreased or not. METHODS: A retrospective study of pediatric patients presenting at the emergency department and referred to the pediatric surgery unit from March 14, 2020 to April 20, 2020 was carried out. The results were compared with those from the same dates of the previous year. Demographic variables, pathologies, and management strategies were studied for each case. The number of patients with abdominal pain requiring surgical assessment was also analyzed. RESULTS: 161 patients were included - 91 from 2019 and 70 from 2020. Of the 2020 patients, 62 (88.6%) underwent surgery and 8 (11.4%) were admitted, whereas in 2019, patient distribution was 67 (73.6%) and 24 (26.4%), which means there were fewer admissions in 2020 (p=0.018). There were no differences in terms of hours to emergency department consultation - just an increase in the case of appendicular pathologies in the 2020 period, with 24 [23-48] hours vs. 24 [12-30] hours (p = 0.045). CONCLUSION: The current pandemic has not caused emergency surgeries to decrease. It has only increased time to consultation in patients with appendicular pathologies.

Influence of the coronavirus 2 (SARS-Cov-2) pandemic on acute appendicitis.

INTRODUCTION: Acute appendicitis (AA) is the most common abdominal surgical emergency. No specific studies have been found that evaluate the impact of the coronavirus 2 (SARS-Cov-2) pandemic on AA and its surgical management. An analysis was made on the influence of this new pathology on the clinical course of AA. MATERIAL AND METHODS: Retrospective observational study was conducted on patients operated on for AA from January to April 2020. They were classified according to the time of the appendectomy, before the declaration of the state of alarm (Pre-COVID-19), and after its declaration (Post-COVID-19) in Spain, one the most affected countries in the world. An evaluation was made of demographic variables, duration of symptoms, type of appendicitis, surgical time, hospital stay, and postoperative complications. RESULTS: The study included 66 patients (41 Pre-COVID-19; 25 Post-COVID-19) with mean age of 10.7 ±â€¯3 and 9.3 ±â€¯3.1; P = .073, respectively. Fever was found in a higher number of post-COVID-19 patients (52 vs 19.5%; P = .013), as well as a higher CRP (72.7 ±â€¯96.2 vs 31.3 ±â€¯36.2 mg/dL; P = .042). This group presented with a higher proportion of complicated appendicitis when compared to Pre-COVID-19 (32 vs 7.3%; P = .015). The mean hospital stay was longer in the Post-COVID-19 group (5.6 ±â€¯5.9 vs 3.2 ±â€¯4.3 days; P = .041). No differences were found in the time of onset of symptoms or surgical time. CONCLUSIONS: The SARS-Cov-2 pandemic influenced the time of diagnosis of appendicitis, as well as its course, and mean hospital stay. Peritonitis was more frequently seen. As a result of the significant circumstances, delaying diagnosis and treatment of AA during SARS-Cov-2 pandemic, inappropriate management of this common surgical disorder has been noticed.

INTRODUCCIÓN: La apendicitis aguda (AA) es la urgencia quirúrgica abdominal más frecuente. No encontramos estudios específicos que evalúen el impacto de la pandemia causada por el coronavirus 2 (SARS-Cov-2) sobre la AA y su tratamiento quirúrgico. Analizamos la influencia de esta nueva patología sobre la AA. MATERIAL Y MÉTODOS: Estudio observacional retrospectivo en pacientes intervenidos por AA desde enero hasta abril de 2020. Fueron clasificados según el momento de la apendicectomía, antes de la declaración del estado de alarma (Pre-COVID19) y después de la declaración del estado de alarma (Post-COVID19) en España. Se evaluaron variables demográficas, duración de la sintomatología, tipo de apendicitis, tiempo quirúrgico, estancia hospitalaria y complicaciones postoperatorias. RESULTADOS: Se incluyeron 66 pacientes (41 Pre-COVID19; 25 Post-COVID19 con edad media de 10.7 ±â€¯3 y 9.3 ±â€¯3.1; P = .073; respectivamente). La fiebre se encontró en un mayor número de pacientes post-COVID19 (52 vs 19.5%; P = .013), así como una PCR más elevada (72.7 ±â€¯96.2 vs 31.3 ±â€¯36.2 mg/dl; P = .042). Este grupo presentó una mayor proporción de apendicitis complicada al compararle con el Pre-COVID19 (32 vs 7.3%; P = .015). La estancia media hospitalaria fue mayor en el grupo Post-COVID19 (5.6 ±â€¯5.9 vs 3.3 ±â€¯4.3 días; P = .041). No se encontraron diferencias en el tiempo de evolución de los síntomas ni en el tiempo quirúrgico. CONCLUSIONES: La pandemia por SARS-Cov-2 influye en el momento de diagnóstico de la apendicitis, así como en su grado de evolución y estancia hospitalaria. La peritonitis fue lo más frecuentemente observado. Una sospecha y orientación clínica más temprana, es necesaria para evitar un manejo inadecuado de este trastorno quirúrgico común.