• Christopher Bastianpillai, Kate Ryan, Sami Hamid, Chi-Ying Li, and GreenJames S AJSAFrom the Whipps Cross University Hospital, Barts Health NHS Trust, London..
• From the Whipps Cross University Hospital, Barts Health NHS Trust, London.
• Pediatr Emerg Care. 2021 Dec 1; 37 (12): e1311e1314e1311-e1314.

ObjectivesAcute scrotal pain in children is a common presenting complaint in hospital, and it is imperative that cases of testicular torsion are identified and managed promptly. We aim to identify the most influential points in the pathway in determining whether patients are managed in the appropriate time frame, so these areas can be targeted to improve salvage rates.MethodsUsing quality improvement principles, the pediatric scrotal pain pathway was mapped out, commencing with initial symptom onset and ending with definitive surgical management. We retrospectively reviewed data on all patients between 0 and 18 years of age attending the emergency department at Whipps Cross University Hospital with acute scrotal pain between October 2010 and October 2013.ResultsOver the 3-year period, 238 patients 18 years or younger presented to casualty with scrotal pain. Of the patients assessed initially by an emergency department physician, 52.8% (n = 67) were discharged without referral. To our knowledge, none of these patients presented later with a missed torsion. Torsion was diagnosed in 23.2% of the patients operated on (n = 22), of which 5 required orchidectomy, comprising 2.1% of all patients presenting with scrotal pain. In this group, 4 were due to late presentation by the patient.ConclusionsWe demonstrate the value of different stages of the pathway, as more than half of patients seen in A&E were correctly discharged without referral. In the context of our study, late presentation to hospital appears to be the most significant factor leading to orchidectomy. To target this issue, awareness among both children and parents must be improved.Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

9 keywords...

hide…