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Did the COVID-19 Pandemic Cause a Delay in the Diagnosis of Acute Appendicitis?

ABSTRACT: BACKGROUND:Appendectomy for acute appendicitis remains one of the most common surgical procedures. This study aims to assess the clinical presentation and delays in diagnosing acute appendicitis during the COVID-19 pandemic. METHODS:We evaluated data of all adult patients who underwent an appendectomy at our hospital between June 1, 2019 and June 1, 2020. Demographic data, admission type to the emergency room, radiological findings, pathological findings, and hospitalization time were noted. Patients were divided into four groups of 3-month periods, pre (Groups 5, 4, 3, 2) and during the pandemic (Group 1). Hospitalization time and perforation status of each group were compared. The hospital admission type and their effect on perforation were also evaluated. RESULTS:Two hundred and fourteen patients were included; 135 patients were male, and 57 were female. The median age was 39 years. In Group 1 (pandemic period), 28.8% of patients were referred to us from pandemic hospitals. The median hospitalization time was 7.3 h before pandemics (Group 2-5), 5 h in the pandemic period (Group 1). Perforation rates were 27.8% in Group 1, 23.3% in Group 2, 16.3% in Group 3, 14.0% in Group 4, and 18.6% in Group 5 (0?=?0.58). There was no difference in the patients in Group 1 in the rate of perforated appendicitis in patients who were referred from other pandemic hospitals (29.4) and those admitted via our own emergency room (16.6%) (p?=?0.27) during the pandemic period. CONCLUSION:We did not observe any clear increase in the diagnosis of perforated appendicitis during the pandemic period, even in patients who were transferred from other hospitals.

SUBMITTER: Turanli S

PROVIDER: S-EPMC7577362 | biostudies-literature | 2020 Oct

REPOSITORIES: biostudies-literature

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Did the COVID-19 Pandemic Cause a Delay in the Diagnosis of Acute Appendicitis?

Turanli Sevim S Kiziltan Gamze G

World journal of surgery 20201021 1

<h4>Background</h4>Appendectomy for acute appendicitis remains one of the most common surgical procedures. This study aims to assess the clinical presentation and delays in diagnosing acute appendicitis during the COVID-19 pandemic.<h4>Methods</h4>We evaluated data of all adult patients who underwent an appendectomy at our hospital between June 1, 2019 and June 1, 2020. Demographic data, admission type to the emergency room, radiological findings, pathological findings, and hospitalization time ...[more]

PMID: 33089347

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Project description:Simple Summary The diagnosis and treatment of patients with bone neoplasms is often a demanding task, and at the same time, inadequate treatment may worsen the patients’ prognosis. During the COVID-19 pandemic, the change of priorities caused a limitation or even a temporal pause of elective healthcare in medical facilities, which included: delays in or rescheduling of outpatient visits, planned diagnostic and therapeutic procedures, as well as a shift towards telemedicine, which precluded the proper physical examination of the patients. Therefore, the aim of our study was to determine how the pandemic influenced the diagnostic and therapeutic processes for patients with primary bone tumors, and what lessons we can learn for the future. In addition, our goal was to verify whether surgical treatment during the COVID-19 pandemic could be safe for patients with bone tumors. In our study, we did not observe an extension of the delay in diagnosis during the COVID-19 pandemic, however, those patients reported to oncology centers with larger tumors compared to those of the patients who were treated before the pandemic. The COVID-19 pandemic had a negative impact on the delay in performing biopsies, however, it did not significantly affect the therapeutic process itself. At the same time, we indicated that the patients with bone tumors can be successfully treated surgically without experiencing an unnecessary delay, if all the precautions are taken. Abstract Background: The COVID-19 pandemic has affected all of the medical specialties, including orthopedic oncology. Therefore, the aim of the study was to assess how it influenced the diagnostic and therapeutic processes for patients with bone neoplasms. Methods: We evaluated 87 patients treated due for bone neoplasms before (Group I, n = 36) and during the COVID-19 pandemic (Group II, n = 51). A delay in diagnosis was defined as the period between the initial clinical symptoms and the date of referral to an oncology center. The patients from Group II were asked to complete a short questionnaire regarding the COVID-19 pandemic. Results: The median general delay in diagnosis before the pandemic was 7 months, while during the pandemic, it was 10 months (p = 0.728). The biopsy delay was lower in the pre-pandemic group: median-6.5 vs. 12 days (p = 0.025). The patients from Group II were diagnosed with larger tumors compared to those in Group I: the median values were 75 vs. 56 mm (p = 0.025), respectively. After an X-ray examination, the bone neoplasms were suspected more frequently in the Group II: 63% vs. 44% cases (p = 0.024), respectively. In Group II, 20 (60.8%) cases of SARS-CoV-2 infection were reported, however, no respiratory failure cases were noticed. Conclusion: The pandemic affected the diagnostic process of primary bone tumors, resulting in delays in performing biopsies. During the pandemic, the patients reported larger diameters of their bone lesions.

Project description:BACKGROUND:Unusual clinical presentation of acute appendicitis in preschool children leads to misdiagnosis and complications. We aimed to analyze the influence of age on clinical presentation, laboratory findings and complications in preschool children with acute appendicitis. METHODS:From January 2012 until December 2017, 29 children younger than 6?years of age (median 50?months) with acute appendicitis were enrolled in this retrospective study. Patients were grouped according to their age: group 1: <?48?months (n?=?13); group 2: >?48?months (n?=?16), their clinical data, laboratory results and complications were compared. RESULTS:In group 1, duration of nausea and vomiting was longer, alteration of general state was more frequent and pain in the right fossa iliaca less frequent than in group 2 (p?=?0.026, p?=?0.000 and p?=?0.029, respectively). Heart rate was higher in group 1 than in group 2 (p?=?0.012). Leucocyte and polynuclear neutrophil counts were lower in group 1 than in group 2 (p?=?0.028 and?=?0.004, respectively) but C-reactive protein levels were not different between groups. In the whole cohort however, C-reactive protein at admission value correlated negatively with age (p?=?0.025). Abdominal ultrasound allowed diagnosis in 19/29 patients (65.5%), without any difference between groups. Appendicular perforation was more frequent in group 1 than in group 2 (p?=?0.003). Perforation was also related to longer hospital stay (p?=?0.018). Peritonitis occurred in 21/29 (72%), post-operative ileus in 5/29 (17%) and sepsis in 4/29 (14%) patients without any difference between groups. In the whole cohort, hospital stay correlated negatively with age (p?=?0.000). There was no mortality. CONCLUSIONS:Among preschool children, those younger than 48?months present with longer duration of pre-admission symptoms indicating longer infection course than in older children. Altered general state and higher degree of tachycardia in the younger reflect higher systemic repercussions of the illness. Less specific abdominal pain and dissociation of the inflammatory markers with lower leucocyte- and neutrophil counts and higher C-reactive protein levels in the younger may contribute to further diagnosis delay and higher rate of perforation in these patients.

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Did the COVID-19 Pandemic Cause a Delay in the Diagnosis of Acute Appendicitis?

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Did the COVID-19 Pandemic Cause a Delay in the Diagnosis of Acute Appendicitis?

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