Incidence of complicated appendicitis in children during the COVID-19 pandemic : systematic review and meta-analysis

Cilj istraživanja: Cilj ovog sustavnog pregleda i meta-analize bio je istražiti utjecaj COVID- 19 pandemije na učestalost kompliciranih oblika apendicitisa u djece u odnosu na predpandemijsko razdoblje. Ispitanici i metode: Provedeno je sustavno pretraživanje četiri baze podataka. Korišteni su pojmovi za pretraživanje kako slijedi: (coronavirus OR SARS-CoV-2 OR COVID-19 OR novel coronavirus) AND (appendicitis). Uključeni su svi bolesnici mlađi od 18 godina kojima je dijagnosticiran akutni apendicitis tijekom i prije COVID-19 pandemije. Uspoređivao se udio djece s kompliciranim oblikom bolesti te udio djece liječene konzervativnim pristupom. Downs and Black ljestvica korištena je za metodološku procjenu kvalitete. Rezultati: Ova je meta-analiza uključivala trinaest istraživanja (dvanaest retrospektivnih i jedno presječno istraživanje). Ukupno je uključeno 2782 bolesnika (1239 tijekom COVID-19 pandemije). Zabilježena je značajno viša učestalost kompliciranih oblika akutnog apendicitisa (RR=1,63; 95% CI 1,33–2,01; p<0,001) te značajno viša učestalost konzervativnog pristupa liječenju u djece oboljele od akutnog apendicitisa (RR=1,95; 95% CI 1,45–2,61; p<0,001) za vrijeme COVID-19 pandemije, u odnosu na razdoblje prije pandemije. Zaključci: Učestalost kompliciranih oblika akutnog apendicitisa u djece značajno je viša tijekom COVID-19 pandemije u odnosu na vrijeme prije pandemije. Nadalje, značajno je viši udio djece oboljele od akutnog apendicitisa liječen konzervativnim pristupom za vrijeme COVID-19 pandemije u odnosu na pred-pandemijsko razdoblje.Objectives: The aim of this systematic review and meta-analysis was to evaluate whether the COVID-19 pandemic resulted in higher incidence of complicated appendicitis in children presenting with acute appendicitis compared to the pre-COVID-19 period. Patients and methods: Systematic search of four scientific databases was performed. The search terms used were (coronavirus OR SARS-CoV-2 OR COVID-19 OR novel coronavirus) AND (appendicitis). The inclusion criteria were all patients aged <18 years and diagnosed with acute appendicitis during the COVID-19 and pre-COVID-19 periods. The proportion of children presenting with complicated appendicitis and the proportion of children managed by non-operative management (NOM) was compared between the two groups. The Downs and Black scale was used for methodological quality assessment. Results: The present meta-analysis included thirteen studies (twelve retrospective studies and one cross-sectional study). A total of 2782 patients (1239 during the COVID-19 period) were included. A significantly higher incidence of complicated appendicitis (RR=1.63; 95% CI 1.33–2.01; p<0.001) and a significantly higher proportion of children managed via the NOM approach (RR=1.95; 95% CI 1.45–2.61; p