Management of Acute Appendicitis in Children During COVID-19 and Perspectives of Pediatric Surgeons From South Asia: Survey Study

  1. Md Jafrul Hannan
  2. Mosammat Kohinoor Parveen
  3. Md Mozammel Hoque
  4. Tanvir Kabir Chowdhury
  5. Md Samiul Hasan
  6. Alak Nandy

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Abstract

Nonoperative treatment (NOT) of pediatric appendicitis as opposed to surgery elicits great debate and is potentially influenced by physician preferences. Owing to the effects of the COVID-19 pandemic on health care, the practice of NOT has generally increased by necessity and may, in a post–COVID-19 world, change surgeons’ perceptions of NOT.

Objective

The aim of this study was to determine whether the use of NOT has increased in South Asia and whether these levels of practice would be sustained after the pandemic subsides.

Methods

A survey was conducted among pediatric surgeons regarding their position, institute, and country; the number of appendicitis cases they managed; and their mode of treatment between identical time periods in 2019 and 2020 (April 1 to August 31). The survey also directly posed the question as to whether they would continue with the COVID-19–imposed level of NOT after the effect of the pandemic diminishes.

Results

A total of 134 responses were collected out of 200 (67.0%). A significant increase in the practice of NOT was observed for the entire cohort, although no effect was observed when grouped by country or institute. When grouped by position, senior physicians increased the practice of NOT the most, while junior physicians reported the least change. The data suggest that only professors would be inclined to maintain the COVID-19–level of NOT practice after the pandemic.

Conclusions

Increased practice of NOT during the COVID-19 pandemic was observed in South Asia, particularly by senior surgeons. Only professors appeared inclined to consider maintaining this increased level of practice in the post–COVID-19 world.

Article activity feed

  1. Version published to 10.2196/26613
  2. Version published to 10.2196/preprints.26613
  3. Version published to 10.1101/2020.10.27.20220442v3 on medRxiv
  4. Version published to 10.1101/2020.10.27.20220442v4 on medRxiv
  5. Version published to 10.1101/2020.10.27.20220442v2 on medRxiv
  6. ScreenIT

    SciScore for 10.1101/2020.10.27.20220442: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: Thank you for sharing your data.

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    The limitation of this study, which is independent of physicians’ personal opinions or preferences, is that the resources and capacities of hospitals will be different, a factor that was not measured in the survey. This could also sway the usage of NOT towards those facilities with the scarcest of capacities and resources. Ultimately, all of these factors can and should contribute to treatment decisions.[26]Even when the effects of the pandemic subside, the economic effects will lag considerably and recovery will be slow. This will, in turn, continue to place economic pressures on institutions that may necessitate longer than anticipated usage of NOT of AUA.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  7. Version published to 10.1101/2020.10.27.20220442v1 on medRxiv