{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T15:01:31Z","timestamp":1787065291396,"version":"build-2736575974"},"reference-count":20,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2021,8,26]],"date-time":"2021-08-26T00:00:00Z","timestamp":1629936000000},"content-version":"unspecified","delay-in-days":25,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Trauma Surg Acute Care Open"],"accepted":{"date-parts":[[2021,8,4]]},"published-print":{"date-parts":[[2021,8]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The early COVID-19 pandemic period significantly strained the US healthcare system. During this period, consultations and admissions for acute medical conditions decreased, which was associated with an increase in disease-specific morbidity and mortality. Therefore, we sought to determine what, if any, effect the early COVID-19 pandemic period had on the presentation, management, and histopathologic severity of acute appendicitis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We performed a retrospective, observational study to compare the frequencies with which patients presented with acute appendicitis, the proportion of whom were managed surgically, and the distribution of histopathologic disease severity among all resected appendix specimens during the early COVID-19 pandemic period (March 6\u2013June 30, 2020) to equivalent time periods for the 3 preceding\/pre-pandemic years (2017\u20132019).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Compared with equivalent pre-pandemic time periods, during the COVID-19 pandemic period there was no significant difference in the number of patients who presented for acute appendicitis, there was a decreased rate of surgical management (81% vs 94%; p=0.014), and there was an overall increase in the incidence of perforated appendicitis (31% vs 16%; p=0.004), including by histopathologic diagnosis (25% vs 11%; p=0.01).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Despite potential patient hesitancy to present for care, the early COVID-19 pandemic period was associated with no significant change in the number of patients presenting with acute appendicitis; however, there was a significant increase in the incidence of perforated appendicitis. This study highlights the need to encourage patients to avoid late presentation for acute surgical conditions and for the robust planning for the medical management of otherwise surgical abnormalities during episodes of restricted or limited resources.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of evidence<\/jats:title>\n                    <jats:p>Level III.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/tsaco-2021-000809","type":"journal-article","created":{"date-parts":[[2021,8,26]],"date-time":"2021-08-26T12:43:46Z","timestamp":1629981826000},"page":"e000809","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":17,"title":["Acute appendicitis severity during the early COVID-19 pandemic period"],"prefix":"10.1136","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3055-2810","authenticated-orcid":false,"given":"Thomas D","family":"Zaikos","sequence":"first","affiliation":[{"name":"Department of Pathology, Johns Hopkins University, Baltimore, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth M","family":"Boudiab","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Beaumont Health, Royal Oak, Michigan, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emanuela C","family":"Peshel","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Beaumont Health, Royal Oak, Michigan, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annie A","family":"Wu","sequence":"additional","affiliation":[{"name":"School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ethan","family":"Dyer","sequence":"additional","affiliation":[{"name":"School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7075-771X","authenticated-orcid":false,"given":"Elliott R","family":"Haut","sequence":"additional","affiliation":[{"name":"Divsion of Acute Care Surgery, Department of Surgery, Johns Hopkins University, Baltimore, Maryland, USA"},{"name":"Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, USA"},{"name":"Department of Emergency Medicine, Johns Hopkins University, Baltimore, Maryland, USA"},{"name":"The Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, Maryland, USA"},{"name":"Department of Health Policy and Management, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7251-1916","authenticated-orcid":false,"given":"Kevan J","family":"Salimian","sequence":"additional","affiliation":[{"name":"Department of Pathology, Johns Hopkins University, Baltimore, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2021,8,26]]},"reference":[{"key":"2025082410361011000_6.1.e000809.1","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1001\/jamasurg.2015.4218","article-title":"Results of yet another antibiotics vs appendectomy randomized trial: still not enough to change my practice","volume":"151","author":"Haut","year":"2016","journal-title":"JAMA Surg"},{"key":"2025082410361011000_6.1.e000809.2","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1097\/TA.0000000000002270","article-title":"Management of acute appendicitis in adults: a practice management guideline from the eastern association for the surgery of trauma","volume":"87","author":"Rushing","year":"2019","journal-title":"J Trauma Acute Care 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appendicitis","volume":"82","author":"Hernandez","year":"2017","journal-title":"J Trauma Acute Care Surg"},{"key":"2025082410361011000_6.1.e000809.7","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajem.2010.04.005"},{"key":"2025082410361011000_6.1.e000809.8","unstructured":"American College of Surgeons . COVID-19 guidelines for triage of emergency general surgery patients. 2020. https:\/\/www.facs.org\/covid-19\/clinical-guidance\/elective-case\/emergency-surgery (15 May 2021)."},{"key":"2025082410361011000_6.1.e000809.9","doi-asserted-by":"crossref","first-page":"593","DOI":"10.1097\/TA.0000000000001127","article-title":"The american association for the surgery of trauma grading scale for 16 emergency general surgery conditions: disease-specific criteria characterizing anatomic severity grading","volume":"81","author":"Tominaga","year":"2016","journal-title":"J Trauma Acute Care Surg"},{"key":"2025082410361011000_6.1.e000809.10","doi-asserted-by":"crossref","first-page":"1097","DOI":"10.1002\/bjs.11646","article-title":"Global guidance for surgical care during the COVID-19 pandemic","volume":"107","year":"2020","journal-title":"Br J Surg"},{"key":"2025082410361011000_6.1.e000809.11","doi-asserted-by":"crossref","first-page":"e204","DOI":"10.1097\/SLA.0000000000004105","article-title":"The effect on trauma care secondary to the COVID-19 pandemic: collateral damage from diversion of resources","volume":"272","author":"Haut","year":"2020","journal-title":"Ann Surg"},{"key":"2025082410361011000_6.1.e000809.12","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMc2009166"},{"key":"2025082410361011000_6.1.e000809.13","doi-asserted-by":"crossref","first-page":"1085","DOI":"10.1097\/TA.0000000000002923","article-title":"Dramatic decrease of surgical emergencies during COVID-19 outbreak","volume":"89","author":"Rausei","year":"2020","journal-title":"J Trauma Acute Care Surg"},{"key":"2025082410361011000_6.1.e000809.14","doi-asserted-by":"crossref","first-page":"2458","DOI":"10.1007\/s00268-020-05599-8","article-title":"The decreasing incidence of acute appendicitis during COVID-19: a retrospective multi-centre study","volume":"44","author":"Tankel","year":"2020","journal-title":"World J Surg"},{"key":"2025082410361011000_6.1.e000809.15","doi-asserted-by":"crossref","first-page":"1508","DOI":"10.1177\/0003134820972098","article-title":"Impact of COVID-19 outbreak on the emergency presentation of acute appendicitis","volume":"86","author":"Kumaira Fonseca","year":"2020","journal-title":"Am Surg"},{"key":"2025082410361011000_6.1.e000809.16","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1016\/j.ijsu.2020.07.002","article-title":"Acute care surgery during the COVID-19 pandemic in Spain: changes in volume, causes and complications. A multicentre retrospective cohort study","volume":"80","author":"Cano-Valderrama","year":"2020","journal-title":"Int J Surg"},{"key":"2025082410361011000_6.1.e000809.17","doi-asserted-by":"publisher","DOI":"10.1016\/j.puhe.2020.10.004"},{"key":"2025082410361011000_6.1.e000809.18","first-page":"37","article-title":"Diagnostic accuracy and perforation rate in appendicitis: association with age and sex of the patient and with appendicectomy rate","volume":"158","author":"Andersson","year":"1992","journal-title":"Eur J Surg"},{"key":"2025082410361011000_6.1.e000809.19","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1001\/jamasurg.2018.4282","article-title":"Nonoperative management of uncomplicated appendicitis among privately insured patients","volume":"154","author":"Sceats","year":"2019","journal-title":"JAMA Surg"},{"key":"2025082410361011000_6.1.e000809.20","doi-asserted-by":"crossref","first-page":"1907","DOI":"10.1056\/NEJMoa2014320","article-title":"A randomized trial comparing antibiotics with appendectomy for appendicitis","volume":"383","author":"Flum","year":"2020","journal-title":"N Engl J Med"}],"container-title":["Trauma Surgery &amp; Acute Care Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/tsaco-2021-000809","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,24]],"date-time":"2025-08-24T17:36:22Z","timestamp":1756056982000},"score":1,"resource":{"primary":{"URL":"https:\/\/tsaco.bmj.com\/lookup\/doi\/10.1136\/tsaco-2021-000809"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,8]]},"references-count":20,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2021,8,26]]},"published-print":{"date-parts":[[2021,8]]}},"alternative-id":["10.1136\/tsaco-2021-000809"],"URL":"https:\/\/doi.org\/10.1136\/tsaco-2021-000809","relation":{},"ISSN":["2397-5776"],"issn-type":[{"value":"2397-5776","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,8]]}}}