Division of Pediatric Surgery, Department of Surgery, NYU Grossman School of Medicine, Hassenfeld Children's Hospital at NYU Langone, New York, NY.
Division of Pediatric Surgery, Department of Surgery, Joseph M. Sanzari Children's Hospital, Hackensack Meridian Health, Hackensack, NJ.
Ann Surg. 2021 Mar 1;273(3):410-415. doi: 10.1097/SLA.0000000000004426.
The aim of the study was to determine whether perforated appendicitis rates in children were influenced by the Coronavirus disease 2019 (COVID-19) surge.
Disruption of care pathways during a public health crisis may prevent children from obtaining prompt assessment for surgical conditions. Progression of appendicitis to perforation is influenced by timeliness of presentation. In the context of state-mandated controls and public wariness of hospitals, we investigated the impact of the COVID-19 outbreak on perforated appendicitis in children.
We conducted an analysis of all children presenting to 3 hospital sites with acute appendicitis between March 1 and May 7, 2020, corresponding with the peak COVID-19 outbreak in the New York City region. Control variables were collected from the same institutions for the preceding 5 years. The primary outcome measure was appendiceal perforation.
Fifty-five children presented with acute appendicitis over 10 weeks. Compared to a 5-year control cohort of 1291 patients, we observed a higher perforation rate (45% vs 27%, odds ratio 2.23, 95% confidence interval 1.29-3.85, P = 0.005) and longer mean duration of symptoms in children with perforations (71 ± 39 vs 47 ± 27 h, P = 0.001) during the COVID-19 period. There were no differences in perforation rates (55% vs 59%, P = 0.99) or median length of stay (1.0 vs 3.0 days, P = 0.58) among children screening positive or negative for SARS-CoV-2.
Children in the epicenter of the COVID-19 outbreak demonstrated higher rates of perforated appendicitis compared to historical controls. Preoperative detection of SARS-CoV-2 was not associated with inferior outcomes. Although children likely avoid much of the morbidity directly linked to COVID-19, disruption to local healthcare delivery systems may negatively impact other aspects of pediatric surgical disease.
本研究旨在确定儿童穿孔性阑尾炎的发生率是否受到 2019 年冠状病毒病（COVID-19）疫情的影响。
在公共卫生危机期间，医疗路径的中断可能会阻止儿童及时获得手术评估。阑尾炎穿孔的进展受就诊及时性的影响。在州政府强制控制和公众对医院的警惕的背景下，我们调查了 COVID-19 爆发对儿童穿孔性阑尾炎的影响。
我们对 2020 年 3 月 1 日至 5 月 7 日期间在 3 家医院就诊的所有急性阑尾炎患儿进行了分析，这与纽约市地区 COVID-19 疫情高峰期相对应。同期在同一机构收集了对照变量。主要观察指标为阑尾穿孔。
在 10 周内有 55 名儿童出现急性阑尾炎。与 5 年的 1291 例患者对照队列相比，我们观察到穿孔率更高（45%比 27%，优势比 2.23，95%置信区间 1.29-3.85，P = 0.005），穿孔患儿的平均症状持续时间更长（71 ± 39 比 47 ± 27 小时，P = 0.001）。在 COVID-19 期间，SARS-CoV-2 检测阳性或阴性的儿童之间穿孔率（55%比 59%，P = 0.99）或中位住院时间（1.0 比 3.0 天，P = 0.58）均无差异。
COVID-19 疫情中心的儿童与历史对照相比，穿孔性阑尾炎的发生率更高。术前检测到 SARS-CoV-2 与不良结果无关。尽管儿童可能避免了与 COVID-19 直接相关的大部分发病率，但当地医疗服务系统的中断可能会对儿科外科疾病的其他方面产生负面影响。
