Impact of COVID-19 on the presentation and course of acute appendicitis in paediatrics

Introduction: Acute appendicitis (AA) is the most frequent urgent surgical pathology in pediatrics. The COVID-19 pandemic has led to a decrease in emergency department (ED) visits, which can lead to a delay in health care and an increase in the severity of the pathologies. The objective is to analyze the rate of complicated AA during the pandemic, compared to the same period of the previous year. Materials and methods: Retrospective unicenter observational cohort study that included patients under 14 years of age seen in the ED with a diagnosis of AA during the months of March to May 2019 (non-pandemic) and 2020 (pandemic). Results: 90 patients were included (41 in non-pandemic and 49 in pandemic). No difference was found between the two periods in the time from the clinic onset until the visit to the ED (37h vs 38 h, p =0.881), but there was a difference in the time from arrival at the ED until the surgery (7:00 h vs 10:30h, p=0.004). The difference was accentuated when comparing the month of March with April-May 2020 (6 h vs 12 h; p =0.001). No significant differences were observed in the rate of complicated AA in intraoperative diagnosis (35% vs 33%; p =0.870) or anatomopathology (35% vs 48%; p = 0.222), nor in the number of postoperative complications, length of hospitalization and readmissions. An increase in the anatomopathological diagnosis of AA with periapendicitis was observed (47% vs 81%; p = 0.001) Conclusion: During the pandemic, a delay from arrival at the ED until the surgery was observed in children diagnosed with AA. This delay resulted in an increase in the diagnosis of histologically evolved AA, but without an increase in the clinical complications of the disease. (C) 2020 Asociacion Espanola de Pediatria. Published by Elsevier Espana, S.L.U.