Pantalos George, Papachristidou Smaragda, Mavrigiannaki Eleftheria, Zavras Nikolaos, Vaos George
Pediatric Intensive Care Unit, Penteli General Children's Hospital, 15236 Athens, Greece.
Second Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, P. & A. Kyriakou Children's Hospital, 11527 Athens, Greece.
Diagnostics (Basel). 2023 Aug 2;13(15):2571. doi: 10.3390/diagnostics13152571.
Global pandemics cause health system disruptions. The inadvertent disruption in surgical emergency care during the Coronavirus Disease 2019 (COVID-19) pandemic has been the topic of several published studies. Our aim was to summarize the reasons that led to the delayed diagnosis of pediatric appendicitis during the COVID-19 era. This systematic literature search evaluated studies containing pediatric appendicitis patient data regarding outcomes, times to hospital admission or times from symptom onset to emergency department visit. Studies elucidating reasons for delays in the management of pediatric appendicitis were also reviewed. Ultimately, 42 studies were included. Several reasons for delayed diagnosis are analyzed such as changes to public health measures, fear of exposure to COVID-19, increased use of telemedicine, COVID-19 infection with concurrent acute appendicitis, recurrence of appendicitis after non-operative management and increased time to intraoperative diagnosis. Time to hospital admission in conjunction with patient outcomes was extracted and analyzed as an indicative measure of delayed management. Delayed diagnosis of acute appendicitis has been documented in many studies with various effects on outcomes. Suspicion of pediatric acute appendicitis must always lead to prompt medical examination, regardless of pandemic status. Telemedicine can be valuable if properly applied. Data from this era can guide future health system policies.
全球大流行会导致卫生系统中断。2019年冠状病毒病（COVID-19）大流行期间外科急诊护理的意外中断一直是多项已发表研究的主题。我们的目的是总结在COVID-19时代导致小儿阑尾炎诊断延迟的原因。这项系统文献检索评估了包含小儿阑尾炎患者结局、入院时间或从症状出现到急诊科就诊时间等数据的研究。还对阐明小儿阑尾炎治疗延迟原因的研究进行了综述。最终纳入了42项研究。分析了诊断延迟的几个原因，如公共卫生措施的变化、对接触COVID-19的恐惧、远程医疗使用增加、COVID-19感染并发急性阑尾炎、非手术治疗后阑尾炎复发以及术中诊断时间增加。提取并分析了入院时间以及患者结局，作为延迟治疗的一项指示性指标。许多研究都记录了急性阑尾炎的诊断延迟情况，这对结局有各种影响。无论大流行状况如何，怀疑小儿急性阑尾炎时都必须立即进行医学检查。如果应用得当，远程医疗可能会很有价值。这个时代的数据可以为未来的卫生系统政策提供指导。
