Acute Appendicitis in Children During War Conflict: Results from a Multicenter Study

Background/Objectives: War conflicts impact public health and patient hospital presentations. We aimed to assess the incidence and severity of acute appendicitis (AA) in children during the 2023 Israeli-Hamas-Hezbollah war. Methods: This multicenter retrospective cohort study included children (<18 years) admitted with AA in six medical centers in a 2-month period during the war (7 October-30 November 2023) and a comparable period in 2022. Demographic, clinical, laboratory, imaging, treatment, and outcome data were collected at individual medical centers and analyzed, with subgroup analysis based on proximity to conflict zones. Statistical tests used were Kolmogorov-Smirnov test, Student's t-test, Mann-Whitney U, and Pearson chi square. p < 0.05 was considered significant. Results: Among 209 patients (106 in 2023, 103 in 2022), a higher rate of complicated AA during wartime was observed, although not statistically significant (27% vs. 18%, p = 0.11). The median symptom-to-presentation time remained 24 h (p = 0.64). The overall incidence of AA decreased by 20% in medical centers near conflict zones but increased by 28% in centers distant from conflict zones. The proportion of complicated AA doubled during the war in hospitals close to conflict zones as compared to during pre-war time (16% vs. 9%, respectively, p = 0.016), with a trend toward higher C-reactive protein (CRP) levels [26.5 (5.3-107.0) vs. 13 (3.4-40.9), respectively, p = 0.075], although symptom-to-presentation times remained unchanged (24 h in both groups, p = 0.32). Conclusions: Proximity to war zones was associated with an increase in the rate of complicated appendicitis in children. While the causes remain unclear, this finding highlights the complex impact of war on healthcare in general and on the well-being of children in particular.