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Imaging pediatric acute appendicitis during the coronavirus disease 2019 (COVID-19) pandemic: collateral damage is variable.
Horst, Kelly K; Kolbe, Amy B; McDonald, Jennifer S; Froemming, Adam T; Parvinian, Ahmad; Klinkner, Denise B; Binkovitz, Larry A.
  • Horst KK; Department of Radiology, Mayo Clinic, 200 1st St. SW, Rochester, MN, 55905, USA. Horst.Kelly@mayo.edu.
  • Kolbe AB; Department of Radiology, Mayo Clinic, 200 1st St. SW, Rochester, MN, 55905, USA.
  • McDonald JS; Department of Radiology, Mayo Clinic, 200 1st St. SW, Rochester, MN, 55905, USA.
  • Froemming AT; Department of Radiology, Mayo Clinic, 200 1st St. SW, Rochester, MN, 55905, USA.
  • Parvinian A; Department of Radiology, Mayo Clinic, 200 1st St. SW, Rochester, MN, 55905, USA.
  • Klinkner DB; Department of Pediatric Surgery, Mayo Clinic, Rochester, MN, USA.
  • Binkovitz LA; Department of Radiology, Mayo Clinic, 200 1st St. SW, Rochester, MN, 55905, USA.
Pediatr Radiol ; 51(11): 1991-1999, 2021 10.
Article in English | MEDLINE | ID: covidwho-1359939
ABSTRACT

BACKGROUND:

Since coronavirus disease 2019 (COVID-19) was declared a worldwide pandemic in March 2020, many authors have noted the collateral damage on non-COVID-19-related illnesses. These indirect effects of the pandemic have resulted in people presenting later and with more severe stages of disease, even if their diagnoses are not directly related to SARS-CoV-2, the virus that causes COVID-19.

OBJECTIVE:

We studied these indirect effects of COVID-19 on the imaging workup and outcomes for pediatric patients at our center who had acute appendicitis during the pandemic. MATERIALS AND

METHODS:

We performed a retrospective review of cases in children ≤18 years who were evaluated for acute appendicitis during the same period, March 1 to May 31, in both 2019 and 2020. We compared demographic and clinical data as well as surgical and pathological findings, and we graded imaging findings according to severity. Differences in patient outcomes were assessed using the Wilcoxon rank sum test and the Pearson chi-square test.

RESULTS:

The total number of pediatric patients evaluated with imaging for acute appendicitis dropped by 43% between 2019 and 2020 (298 vs. 169), but the total number of children treated remained similar (59 vs. 51). There was proportionate use of US and CT in each timeframe but a higher percentage of positive imaging findings in 2020 (50/169, 29.6% vs. 56/298, 18.7% in 2019, P=0.04). There were more imaging examinations with features of complicated appendicitis among positive cases (9/51, 18% vs. 5/59, 8% in 2019, P=0.08) and more pathologically proven perforated cases during the pandemic (14/51, 27% vs. 6/59, 10% in 2019, P=0.11), although these results did not reach statistical significance. There were no changes in surgical management, vital signs, laboratory values, length of stay or complication rates.

CONCLUSION:

There was a large drop in the number of pediatric patients imaged for acute appendicitis during the acute phase of the COVID-19 pandemic despite similar numbers of patients treated. The utilization trends of US vs. CT remained stable between time periods. The differences in imaging findings and perforation rates were less pronounced compared to other published studies.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pediatrics / Appendicitis / Tomography, X-Ray Computed / Pandemics / COVID-19 Type of study: Experimental Studies / Observational study / Prognostic study Limits: Child / Female / Humans / Male Language: English Journal: Pediatr Radiol Year: 2021 Document Type: Article Affiliation country: S00247-021-05128-2

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pediatrics / Appendicitis / Tomography, X-Ray Computed / Pandemics / COVID-19 Type of study: Experimental Studies / Observational study / Prognostic study Limits: Child / Female / Humans / Male Language: English Journal: Pediatr Radiol Year: 2021 Document Type: Article Affiliation country: S00247-021-05128-2