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. 2023 Apr;64(4):249-254.
doi: 10.11622/smedj.2022032.

Management of acute testicular pain in children: changing trends with improvements in scrotal ultrasonography over 18 years

Lin Kyaw  1 , Candy Suet Cheng Choo  2 , Lin Yin Ong  3 , Te-Lu Yap  3 , Harvey James Teo  4 , Shireen Anne Nah  5
Affiliations

Management of acute testicular pain in children: changing trends with improvements in scrotal ultrasonography over 18 years

Lin Kyaw et al. Singapore Med J. 2023 Apr.

Abstract

Introduction: Doppler scrotal ultrasonography (US) is the modality of choice in diagnosing testicular torsion. We aimed to evaluate the performance of scrotal US in diagnosing testicular torsion over the past 18 years in our institution and determine the factors contributing to the length of wait times for it.

Methods: A retrospective review was conducted of boys who presented with acute scrotal pain from 2014 to 2015. US reports, operative findings, final diagnosis and key time points of the patients' journey (time to emergency department consultation, time to admission, time to US and time to operating theatre [OT]) were collected. US performance results were compared with those observed in a historical cohort from 1998 to 2004. Wait times were compared between operated and non-operated patients.

Results: Data from 519 boys with a mean age of 9.15 years was collected. Of these, 438 (84.4%) boys had undergone initial scrotal US; of these scrotal US cases, 28 were surgically explored, with 23 confirmed to have torsion. Another five cases were explored without prior US, and all were confirmed to have torsion. Performance analysis of US showed a sensitivity of 100% and a specificity of 98.8%. There was no significant difference between wait times of operated and non-operated patients. Time to US (P < 0.0001, r = 0.96) and time to OT (P < 0.0001, r = 0.64) correlated significantly with the total time from presentation to surgery.

Conclusion: There has been an improvement in the diagnostic performance of scrotal US for testicular torsion over the past 18 years. Quality improvement programmes targeted at reducing wait times for patients presenting with acute scrotum should target time to US and time to OT.

Keywords: Acute scrotum; emergency; testicular torsion; timing; ultrasonography.

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Conflict of interest statement

None

Figures

Figure 1
Figure 1
Flowchart shows the study cohort.
Figure 2
Figure 2
Graph shows the correlation between the total time from triage to operating theatre (OT) and various key wait times. (a) Time from triage to emergency department (ED) consultation vs. total time from triage to OT. (b) Time from ED consultation to admission vs. total time from triage to OT. (c) Time from admission to scrotal ultrasonography vs. total time from triage to OT. (d) Time to surgery from scrotal ultrasonography compared to total time from triage to OT.
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