Limiting hospital resources for acute appendicitis in children: Lessons learned from the US epicenter of the COVID-19 pandemic
Limiting hospital resources for acute appendicitis in children: Lessons learned from the US epicenter of the COVID-19 pandemic
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DOI：
10.1016/j.jpedsurg.2020.06.024
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发表时间：
2021-05-08
影响因子：
2.4
通讯作者：
Cohen, Chethan Sathya
中科院分区：
文献类型：
--
作者：
Kvasnovsky, Charlotte L.;Shi, Yan;Cohen, Chethan Sathya
引言：COVID-19大流行导致整个纽约的非紧急手术暂停。我们的三级保健儿童医院转向在所有患者中进行静脉（IV）抗生素治疗的简短试验，以限制手术室（OR）的使用并避免延长住院时间。我们描述了我们的流行病为基础的战略，非手术治疗（NOM）阑尾炎，但与IV抗生素的持续时间有限。研究方法：我们对2020年3月31日至2020年5月3日纽约大流行高峰期间在我中心接受急性阑尾炎治疗的儿童进行了一项回顾性研究。我们将阑尾炎的体积与前几年类似月份的阑尾炎体积进行了比较。我们评估了NOM的失败，住院时间，并比较了我们成功地与我们的扩大NOM协议，以前发表的纳入标准NOM. Results：45.5%的急性阑尾炎的儿童（25/55）进行NOM的特点。30例接受手术，13例有复杂性阑尾炎，而17例有单纯性阑尾炎。三名患者呈COVID阳性，但无呼吸道症状。大多数急性阑尾炎患者（78.2%）不符合先前公布的NOM. Conclusions标准：我们治疗了类似量的儿童急性阑尾炎在大流行期间相比，前几年。我们对近一半的患者进行了非手术治疗，尽管我们扩大了NOM的入选标准以减少OR使用，但限制了抗生素试验的持续时间以避免延长住院时间。研究类型：回顾性研究。证据等级：IV。(c)2020爱思唯尔公司All rights reserved.
Introduction: The COVID-19 pandemic resulted in the suspension of nonemergent surgeries throughout New York. Our tertiary care children's hospital pivoted towards a brief trial of intravenous (IV) antibiotic therapy in all patients in order to limit operating room (OR) utilization and avoid prolonged hospital stays. We describe our pandemic-based strategy for non-operative management (NOM) of appendicitis but with a limited duration of IV antibiotics. Methods: We performed a retrospective study of children treated for acute appendicitis at our center from 3/31/ 2020 to 5/3/2020 during the peak of the New York pandemic. We compared appendicitis volume to similar months in prior years. We evaluated failure of NOM, length of stay, and compared characteristics of children we successfully treated with our expanded NOM protocol to previously published inclusion criteria for NOM. Results: 45.5% of children (25/55) with acute appendicitis underwent NOM. Of the 30 who underwent surgery, 13 had complicated appendicitis while 17 had simple appendicitis. Three patients were COVID-positive, although none had respiratory symptoms. The majority of patients presenting with acute appendicitis (78.2%) did not meet previously published criteria for NOM. Conclusions: We treated a similar volume of children with acute appendicitis during the pandemic compared to prior years. We applied non-operative management to nearly half our patients, even as we expanded inclusion criteria for NOM to reduce OR utilization, but limited the duration of the antibiotic trial to avoid prolonged hospital stays.Type of study: Retrospective study.Level of evidence: IV.(c) 2020 Elsevier Inc. All rights reserved.