History and physical examination findings predictive of testicular torsion: An attempt to promote clinical diagnosis by house staff - Abstract

Division of Pediatric Urology, Cohen Children's Medical Center of New York, North Shore-Long Island Jewish Health System, Long Island, 1999 Marcus Avenue, M18, Lake Success, NY 11042, USA.

 

To standardize the history and physical examination of boys who present with acute scrotum and identify parameters that best predict testicular torsion.

Over a 5-month period, a standardized history and physical examination form with 22 items was used for all boys presenting with scrotal pain. Management decisions for radiological evaluation and surgical intervention were based on the results. Data were statistically analyzed in correlation with the eventual diagnosis.

Of the 79 boys evaluated, 8 (10.1%) had testicular torsion. On univariate analysis, age, worsening pain, nausea/vomiting, severe pain at rest, absence of ipsilateral cremaster reflex, abnormal testicular position and scrotal skin changes were statistically predictive of torsion. After multivariate analysis and adjusting for confounding effect of other co-existing variables, absence of ipsilateral cremaster reflex (P < 0.001), nausea/vomiting (P < 0.05) and scrotal skin changes (P < 0.001) were the only consistent predictive factors of testicular torsion.

An accurate history and physical examination of boys with acute scrotum should be primary in deciding upon further radiographic or surgical evaluation. While several forces have led to less consistent overnight resident staffing, consistent and reliable clinical evaluation of the acute scrotum using a standardized approach should reduce error, improve patient care and potentially reduce health care costs.

Written by:
Srinivasan A, Cinman N, Feber KM, Gitlin J, Palmer LS.   Are you the author?

Reference: J Pediatr Urol. 2011 Mar 29. Epub ahead of print.
doi: 10.1016/j.jpurol.2010.12.010

PubMed Abstract
PMID: 21454130

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