ABSTRACT
Objective: Although COVID-19 in childhood is often asymptomatic or has a more benign course, the safety of healthcare workers should be the primary goal because of the risk of contamination. In our study, we aimed to investigate the asymptomatic COVID-19 PCR positivity and its effect on the development of complications in emergency and non-deferred surgery cases that will help both the patient, the operating room and the health care workers. Material and Methods: This is a prospective study that was performed in patients under 18 years of age who were operated on due to emergency and urgent cases in the Ankara City Children's Hospital, which was serving as an anti-pandemic hospital. The patients were evaluated from May 1 to October 1, 2020. Of the 458 patients, 433 patients who met the criteria were included in the study. COVID-19 Nasopharyngeal swab (PCR) samples were taken from all patients along with preoperative examinations. Results: Of the 433 cases included in the study, 155 (33.5%) were girls and 278 (66.5%) were boys. It was determined that emergency cases constituted 389 (89.8%) of all cases. The most common emergency pathologies according to age groups were intestinal obstruction or atresia in the neonatal period, foreign body aspirations of the respiratory tract in the preschool period, and acute appendicitis in the school age. Nasal swab PCR results were positive in only four patients, this rate was found to be 0.9% in the entire study group, and postoperative complications and transmission to healthcare workers were detected at none. Conclusion: In this prospective study, low COVID-19 PCR positivity (0.9% prevalence) was detected in asymptomatic children scheduled for emergency or non-deferred surgery, and we believe that it will shed light on the planning of safe procedure practices. (English) [ABSTRACT FROM AUTHOR] Amaç: Çocukluklarda COVID-19 sıklıkla asemptomatik ya da daha selim bir seyre sahip olsa da temas riskinden dolayı sağlık çalışanlarının güvenliği asıl hedef olmalıdır. Çalışmamızda hem hasta hem ameliyathane hem de sağlık çalışanlarının iş güvenliğine ışık tutacak acil ve ertelenemeyen cerrahi olgularında asemptomatik COVID-19 PCR pozitifliğini araştırmayı amaçladık. Gereç ve Yöntemler: Çalışmamız pandemi hastanesine dahil çocuk hastanesinin çocuk cerrahisi kliniğine acil ve ertelenemeyen cerrahi nedenler ile başvuran 18 yaş altı olgular için tasarlanmış olup ileriye dönük yapılmış tek merkezli bir çalışmadır. Çalışmaya Mayıs 2020 -Ekim 2020 tarihleri arası altı aylık izlemde acil ve ertelenemeyen cerrahi yapılan olgular dahil edildi. Belirtilen tarihler arasında başvuran 458 hasta değerlendirildi ve kriterleri karşılayan 433 hasta çalışma kapsamında değerlendirildi. olgulardan preoperatif muayene ve tetkik esnasında COVID-19 için nazofaringeal sürüntü (PCR) örneği alındı. Bulgular: Çalışmaya dahil edilen 433 olgunun 155'i kız (%33.5), 278'i (%66.5) erkekti. Yaş ortalaması 9.5 yıl olarak hesaplandı. Acil vakaların tüm olguların 389'unu (%89.8) oluşturduğu saptandı. Yaş gruplarına göre en sık acil patolojilerin;yenidoğan döneminde intestinal obstrüksiyon veya atreziler, okul öncesi dönemde solunum yoluna yabancı cisim aspirasyonlar, okul çağında akut apandisit olduğu görüldü. Nazal sürüntü PCR sonuçları sadece dört hastada pozitif bulundu, bu oranın tüm çalışma grubunda %0.9 olduğu görüldü, bu olguların hiçbirinde postoperatif komplikasyon ve sağlık çalışanına bulaş saptanmadı. Sonuç: Bu prospektif çalışma ile acil veya ertelenemeyen cerrahi planlanan asemptomatik çocuklarda düşük COVID-19 PCR pozitifliği (%0.9 prevalans) tespit edilmiş olup güvenli prosedür uygulamalarının planlanmasına ışık tutacağı kanaatindeyiz. (Turkish) [ABSTRACT FROM AUTHOR] Copyright of Journal of Pediatric Disease / Cocuk Hastaliklari Dergisi is the property of Turkish Journal of Pediatric Disease and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
ABSTRACT
INTRODUCTION: The aim of this study was to make the differential diagnosis between acute appendicitis and multisystem inflammatory syndrome in children (MIS-C) for patients presenting with the complaint of acute abdominal pain (AAP) and to identify the determining factors for the diagnosis of MIS-C. MATERIALS AND METHODS: Eighty-one children presenting with AAP/suspected AAP were evaluated. Of these, 24 (29.6%) were included in the MIS-C group (MIS-C/g) and 57 were included in the suspected appendicitis group (S-A/g), which consisted of two subgroups: appendicitis group (A/g) and control observation group (CO/g). RESULTS: Comparing MIS-C/g, A/g, and CO/g, duration of abdominal pain (2.4, 1.5, 1.8 days), high-grade fever (38.8, 36.7, 37°C), severe vomiting, and severe diarrhea were higher in MIS-C/g. Lymphocytes count (LC) was lower, while values of C-reactive protein (CRP), ferritin, and coagulopathy were higher in MIS-C/g (p < 0.05). The optimal cutoffs for the duration of abdominal pain was 2.5 days; the duration of fever, 1.5 days; peak value of fever, 39°C; neutrophil count, 13,225 × 1,000 cell/µMoL; LC, 600 × 1,000 cell/µMoL; ferritin, 233 µg/L; and D-dimer, 16.4 mg/L (p < 0.05). The optimal cutoff for CRP was 130 mg/L (sensitivity 88.9, specificity 100%, positive predictive value 100%, NPV, negative predictive value 92.5%, p < 0.001). All patients in MIS-C/g tested positive by serology by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). CONCLUSION: The duration of abdominal pain, presence of high-grade and prolonged fever, and evaluation of hemogram in terms of high neutrophil count and low LC exhibit high sensitivity and negative predictive value for MIS-C presenting with AAP. In case of doubt, inflammatory markers such as CRP, ferritin, D-dimer, and serology for SARS-CoV-2 should be studied to confirm the diagnosis.