The problem of providing medical care to children with abdominal syndrome at the pre-hospital stage

The analysis of Moscow “Algorithms for Emergency and Urgent Medical Care” for the main surgical pathologies causing acute abdominal syndrome in children was conducted. It was found that current emergency medical care algorithms for children with an acute abdomen (acute appendicitis, cholecystitis, pancreatitis, testicular torsion, and ovarian apoplexy) identify emergency medical evacuation to a hospital as the primary approach. In cases of refusal of hospitalization, the algorithms do not provide for further active patient monitoring and are limited to a recommendation to seek medical care at an outpatient clinic. An exception to these conditions is ovarian apoplexy, where the algorithm includes a repeat active call after 2 hours if hospitalization is refused. Two clinical cases of children with acute abdomen who were admitted to hospital after their parents initially refused hospitalization proposed by the ambulance team were analyzed. Both cases demonstrate that refusing urgent hospitalization leads to a dangerous delay in specialized surgical care, increasing the risk of destructive appendicitis and peritonitis. Thus, current treatment approach does not provide mechanisms for monitoring the condition of a child who remains at home after refusing hospitalization, despite the potentially life-threatening nature of the condition. We recommend incorporating a mandatory active monitoring of the child for 4–6 hours after refusing initial hospitalization in emergency care algorithms for acute appendicitis, acute cholecystitis, acute pancreatitis, and testicular torsion in children. This innovation will allow prompt hospitalization of the child if the condition worsens, minimize the time from the onset of symptoms to the provision of specialized surgical care, and prevent the development of severe purulent-inflammatory complications.

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