Increase in pediatric complicated appendicitis during the COVID-19 pandemic: a multi-center retrospective study

Area of Science:

• Pediatric Surgery
• Infectious Disease Epidemiology
• Public Health

Background:

• Reports indicate a rise in pediatric complicated appendicitis (CA) globally during the COVID-19 pandemic.
• Understanding the pandemic's specific impact on pediatric CA in Japan is crucial.

Purpose of the Study:

• To investigate the effect of the COVID-19 pandemic on the incidence and characteristics of pediatric complicated appendicitis in Japan.
• To compare pediatric CA rates and disease severity between pandemic and pre-pandemic periods.

Main Methods:

• Retrospective review of pediatric appendicitis cases (≤15 years) across 5 Japanese medical centers.
• Comparison of data from the pandemic period (Jan-Oct 2020) with a pre-pandemic control period (Jan-Oct 2017-2019).
• Analysis included incidence of CA, disease characteristics, and pre-operative symptom duration.

Main Results:

• The incidence of pediatric CA significantly increased during the pandemic (32.7%) compared to the pre-pandemic period (18.2%, p=0.02).
• In centers with reduced patient numbers, CA incidence rose from 16.3% to 37.9% (p=0.01), with prolonged pre-operative symptoms (1.3 to 1.7 days, p=0.03).
• No significant differences were observed in age, sex, white blood cell count, C-reactive protein, or body temperature; no SARS-CoV-2 diagnoses were reported.

Conclusions:

• Pediatric complicated appendicitis incidence rose during the COVID-19 pandemic in Japan.
• Delayed hospital presentation due to COVID-19 fears may contribute to increased CA rates and severity.
• Further research is needed to confirm the causal link between pandemic-related anxieties and pediatric appendicitis outcomes.