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      Is there an increased incidence of orchiectomy in pediatric patients with acute testicular torsion during COVID-19 pandemic? - A retrospective multicenter study

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          Abstract

          Introduction

          Testicular torsion is a real emergency condition which requires prompt diagnosis and surgical management to prevent testicular loss. During the coronavirus (COVID-19) pandemic, an increased avoidance of the emergency departments for non-COVID-19 illnesses has been reported in the medical literature.

          Objective

          The aim of this study was to investigate whether the COVID-19 pandemic caused increased number of orchiectomies in pediatric patients presenting with acute testicular torsion compared to pre-COVID-19 period.

          Study design

          A total number of 119 pediatric patients who underwent surgery for acute testicular torsion from January 2019 to December 2020 were enrolled in retrospective multi-center study from six institutions in Croatia. The patients were divided in two groups. The first group (pre-COVID-19) consisted of the patients who underwent surgery before COVID-19 pandemic (n=68), while the second group (COVID-19) consisted of the patients who underwent surgery during the COVID-19 pandemic (n=51). Main outcomes of the study were orchiectomy rates and time from onset of the symptoms to emergency department presentation.

          Results

          During the COVID-19 pandemic period 43.1% (22/51) of the patients underwent orchiectomy while orchiectomy was performed in 16.2% (11/68) of the patients from the pre-COVID group (p=0.001). Median time from onset of the symptoms to emergency department presentation during COVID-19 pandemic and pre-COVID-19 periods was 14h (IQR 5, 48) and 6h (IQR 3, 22) (p=0.007), respectively. A higher proportion of patients waited over 24 h to present to emergency department during the COVID-19 pandemic compared to the pre-COVID-19 period (47% vs 8.8%, p=0.007).

          Conclusion

          During COVID-19 pandemic a significantly higher rates of orchiectomies and increase in delayed presentations for testicular torsion was found. More patient education during pandemic in regards to management of emergency conditions such as testicular torsion is required.

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          Potential indirect effects of the COVID-19 pandemic on use of emergency departments for acute life-threatening conditions — United States, January–May 2020

          Samantha J. Lange, Matthew D. Ritchey, Alyson B. Goodman … (2020)
          This article describes a significant decline in emergency department visits for acute life-threatening conditions during the COVID-19 pandemic, suggesting that patients may be delaying or avoiding care or unable to access care during the pandemic.
          Article 0 comments Cited 56 times – based on 0 reviews     Review now
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            Delayed presentation and sub-optimal outcomes of pediatric patients with acute appendicitis during the COVID-19 pandemic

            Claire D. Gerall, Jennifer Defazio, Anastasia M. Kahan … (2020)
            Objective Early presentation and prompt diagnosis of acute appendicitis are necessary to prevent progression of disease leading to complicated appendicitis. We hypothesize that patients had a delayed presentation of acute appendicitis during the COVID-19 pandemic, which affected severity of disease on presentation and outcomes. Patients and methods We conducted a retrospective review of all patients who were treated for acute appendicitis at Morgan Stanley Children's Hospital (MSCH) between March 1, 2020 and May 31, 2020 when the COVID-19 pandemic was at its peak in New York City (NYC). For comparison, we reviewed patients treated from March 1, 2019 to May 31, 2019, prior to the pandemic. Demographics and baseline patient characteristics were analyzed for potential confounding variables. Outcomes were collected and grouped into those quantifying severity of illness on presentation to our ED, type of treatment, and associated post-treatment outcomes. Fisher's Exact Test and Kruskal-Wallis Test were used for univariate analysis while cox regression with calculation of hazard ratios was used for multivariate analysis. Results A total of 89 patients were included in this study, 41 patients were treated for appendicitis from March 1 to May 31 of 2019 (non-pandemic) and 48 were treated during the same time period in 2020 (pandemic). Duration of symptoms prior to presentation to the ED was significantly longer in patients treated in 2020, with a median of 2 days compared to 1 day (p = 0.003). Additionally, these patients were more likely to present with reported fever (52.1% vs 24.4%, p = 0.009) and had a higher heart rate on presentation with a median of 101 beats per minute (bpm) compared to 91 bpm (p = 0.040). Findings of complicated appendicitis on radiographic imaging including suspicion of perforation (41.7% vs 9.8%, p < 0.001) and intra-abdominal abscess (27.1% vs 7.3%, p = 0.025) were higher in patients presenting in 2020. Patients treated during the pandemic had higher rates of non-operative treatment (25.0% vs 7.3%, p = 0.044) requiring increased antibiotic use and image-guided percutaneous drain placement. They also had longer hospital length of stay by a median of 1 day (p = 0.001) and longer duration until symptom resolution by a median of 1 day (p = 0.004). Type of treatment was not a predictor of LOS (HR = 0.565, 95% CI = 0.357–0.894, p = 0.015) or duration until symptom resolution (HR = 0.630, 95% CI = 0.405–0.979, p = 0.040). Conclusion Patients treated for acute appendicitis at our children's hospital during the peak of the COVID-19 pandemic presented with more severe disease and experienced suboptimal outcomes compared to those who presented during the same time period in 2019. Level of Evidence III
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              A Retrospective Analysis of the Trends in Acute Appendicitis During the COVID-19 Pandemic

              Paige Finkelstein, Omar Picado, Kiranmayi Muddasani … (2021)
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Pediatr Urol
                Journal ID (iso-abbrev): J Pediatr Urol
                Title: Journal of Pediatric Urology
                Publisher: Journal of Pediatric Urology Company. Published by Elsevier Ltd.
                ISSN (Print): 1477-5131
                ISSN (Electronic): 1873-4898
                Publication date PMC-release: 1 May 2021
                Publication date (Electronic): 1 May 2021
                Affiliations
                [a ]Department of Pediatric Surgery, University Hospital of Split, Spinčićeva 1, Split, Croatia
                [b ] University of Split , School of Medicine , Šoltanska 2 , Split , Croatia
                [c ]Department of Pediatric Surgery, University Hospital of Rijeka, Krešimirova 42, Rijeka, Croatia
                [d ]Department of Surgery, Division of pediatric surgery and urology, University Hospital Centre Zagreb, Kišpatićeva 12, Zagreb, Croatia
                [e ]Department of Pediatric Surgery, University Hospital of Osijek, Josipa Huttlera 4, Osijek, Croatia
                [f ]Department of Urology, University Hospital of Osijek, Josipa Huttlera 4, Osijek, Croatia
                [g ]Department of Pediatric Surgery, General Hospital Šibenik, Stjepana Radića 83, Šibenik, Croatia
                [h ]Department of Pediatric Surgery, General Hospital Zadar, Bože Peričića 5, Zadar, Croatia
                Author notes
                [∗ ]Correspondence to: Prof. Zenon Pogorelić, M.D., Ph.D. Department of Pediatric Surgery, Head University Hospital of Split, Spinčićeva 1, 21000 Split, Croatia. Tel.: +38521556654.
                Article
                Publisher Item ID: S1477-5131(21)00225-4
                DOI: 10.1016/j.jpurol.2021.04.017
                PMC ID: 8087574
                PubMed ID: 33994321
                SO-VID: b19bd997-6805-44aa-bd61-ad40993764ff
                Copyright © © 2021 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.
                License:

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

                History
                Date received : 24 February 2021
                Date revision received : 9 April 2021
                Date accepted : 25 April 2021
                Categories
                Subject: Article

                Keywords: testicular torsion,acute scrotum,covid-19,pandemic,urologic emergencies,children
                Data availability:
                Keywords: testicular torsion, acute scrotum, covid-19, pandemic, urologic emergencies, children

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