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Imaging pediatric acute appendicitis during the coronavirus disease 2019 (COVID-19) pandemic: collateral damage is
Kelly K Horst1, Amy B Kolbe2, Jennifer S McDonald2
1Department of Radiology, Mayo Clinic, 200 1st St. SW, Rochester, MN, 55905, USA. Horst.Kelly@mayo.edu.
Insights
The COVID-19 pandemic saw fewer pediatric appendicitis imaging studies, yet treatment numbers remained stable. Complicated appendicitis and perforation rates increased, though not significantly, during this period.
Area of Science:
- Pediatric Imaging
- Gastrointestinal Diseases
- Epidemiology
Background:
- The COVID-19 pandemic has caused significant collateral damage to non-COVID-19 healthcare, leading to delayed diagnoses and advanced disease stages.
- Indirect effects of the pandemic on healthcare access and patient presentation for various conditions have been widely reported.
Purpose of the Study:
- To investigate the indirect effects of the COVID-19 pandemic on the imaging workup and outcomes of pediatric patients diagnosed with acute appendicitis.
- To compare imaging findings, treatment, and outcomes for acute appendicitis in pediatric patients before and during the COVID-19 pandemic.
Main Methods:
- Retrospective review of pediatric patients (≤18 years) evaluated for acute appendicitis between March 1 and May 31, 2019, and 2020.
- Comparison of demographic, clinical, surgical, and pathological data, including imaging severity grading.
- Statistical analysis using Wilcoxon rank sum test and Pearson chi-square test to assess outcome differences.
Main Results:
- A 43% decrease in pediatric patients imaged for appendicitis occurred in 2020 compared to 2019, with similar numbers of children treated.
- A higher percentage of positive imaging findings (29.6% vs. 18.7%) and features of complicated appendicitis (18% vs. 8%) were observed in 2020.
- Pathologically proven perforation rates were higher in 2020 (27% vs. 10%), but these differences did not reach statistical significance. No significant changes in surgical management or complication rates were noted.
Conclusions:
- The initial phase of the COVID-19 pandemic led to a substantial reduction in pediatric appendicitis imaging studies, despite consistent treatment volumes.
- While trends in ultrasound (US) versus computed tomography (CT) utilization remained stable, imaging findings and perforation rates showed less pronounced differences than reported in other studies.
- The study highlights the pandemic's impact on healthcare utilization for acute appendicitis in children, with a notable increase in imaging findings suggestive of complicated disease.
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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