Indicators and outcomes of transfer to tertiary pediatric hospitals for patients with testicular torsion

Preece, Janae; Ching, Christina B.; Yackey, Katelyn; Jayanthi, Venkata R.; McLeod, Daryl J.; Alpert, Seth A.; DaJusta, Daniel

doi:10.1016/j.jpurol.2017.03.034

Cited by 29 publications

(24 citation statements)

References 17 publications

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“…These findings agree with Bayne’s ( 26 ), that reported a positive association between inter-hospital transfer and orchidectomy, especially in boys with presentation delay <24 hours. Likewise, Preece and associates ( 14 ) found that patients transferred within 24 hours of symptoms to their tertiary hospital had twice the probability of testicular loss (30%, versus 15% for those first seen at their tertiary hospital). Although investigators from California ( 15 ) described comparable salvage rates between patients transferred or examined at their tertiary hospital, the mean time from symptoms to operating room between them differed by only 83 minutes.…”

Section: Discussionmentioning

confidence: 96%

“…While the time interval between symptoms and first medical assessment, i.e. presentation delay, rests upon the patient’s awareness of the disease and medical care availability ( 11 - 13 ), delays from this first assessment until evaluation at the treating institution have been associated with the first examining physician’s clinical diagnosis and subsequent action, such as imaging studies orders and inter-hospital patient referral and transfer ( 14 - 16 ). This information, however, comes from economically advanced countries, and although one may postulate that similar associations should also be observed in emerging countries, region-specific data is necessary to ascertain not only the existence but also the magnitude of these associations.…”

Section: Introductionmentioning

confidence: 99%

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Presentation delay, misdiagnosis, inter-hospital transfer times and surgical outcomes in testicular torsion: analysis of statewide case series from central Brazil

Filho

Maroccolo²,

Ribeiro³

et al. 2020

Int. braz j urol.

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Purpose: To estimate statewide presentation delay, misdiagnosis rate, inter-hospital transfer times and testicular salvage for testicular torsion patients treated in our state's public health system. Patients and Methods: Case series of consecutive testicular torsion patients treated in our state's public health system between 2012-2018. Predictors included presentation delay (time from symptoms to first medical assessment), facilitie's level-of-care (primary, secondary, tertiary), first diagnosis (torsion, epididymitis, other), Doppler-enhanced ultrasound request (Doppler-US) and inter-hospital transfer times, with surgical organ salvage as the main response. We used Bayesian regression to estimate the effect of first examining facilitie's level-of-care, first diagnosis, and Doppler-US on transfer time. Results: 505 patients were included, most (298, 59%) with presentation delay >6 hours. Misdiagnosis at first examining facility raised transfer time from median 2.8 to 23.4 (epididymitis) and 37.9 hours (other) and lowered testicular salvage rates from 60.3% (torsion) to 10.7% (epididymitis) and 18.3% (other). Doppler-US had negligible effects on transfer time once controlling for misdiagnosis in the regression model. Although organ salvage in patients presenting before 6 hours at the tertiary facility was high (94.6%, and about 20% lower for those presenting at lower levels-of-care), the overall salvage rate was more modest (46%). Conclusion: Our low overall testicular salvage rates originated from a large proportion of late presentations combined with long transfer times caused by frequent misdiagnoses. Our results indicate that efforts to improve salvage rates should aim at enhancing populationwide disease awareness and continuously updating physicians working at primary and secondary levels-of-care about scrotal emergencies.

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Section: Discussionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

Presentation delay, misdiagnosis, inter-hospital transfer times and surgical outcomes in testicular torsion: analysis of statewide case series from central Brazil

Filho

Maroccolo²,

Ribeiro³

et al. 2020

Int. braz j urol.

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“…Zini et al [13] showed that the delay between the patients' arrival at the emergency department and the surgery was 2.6 times longer when an ultrasound was performed (p < 0.001). Preece et al [14] made the same finding even though the correlation was not significant. Therefore, we agree with Sauvat et al [15] and Zini et al [13] that, if there is a slightest doubt, surgical exploration should immediately be carried out in order to reduce the management delay and hence the risk of orchiectomy.…”

Section: Discussionmentioning

confidence: 76%

Predictive factors for orchiectomy in adult’s spermatic cord torsion: a case‐control study

Kaboré

Kabore

Kaboré

et al. 2021

Basic Clin. Androl.

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Background Spermatic cord torsion (SCT) is a surgical emergency. Any delay in diagnosis or treatment may compromise the vital and functional prognosis of the testicle. The orchiectomy rate remains very high in the literature; it can even reach 50 % in certain series. Several factors have been reported in the literature as being significantly correlated with the risk of orchiectomy: duration of symptoms, the number of turns, the younger ages, etc. The objective of this study has been to analyse the predictive factors of orchiectomy in adult SCT in our context. Results During the study period, 74 cases of SCT were included. Orchidopexy was performed in 43.2 % (32/74) versus orchiectomy in 56.8 % (42/74) of cases. The patients’ median age was 22 years (interquartile range (IQR) = 18–26.75 years). The duration of symptoms (p = 0.009), the previous medical management (p < 0.001), performing a scrotal ultrasonography (p = 0.004) were statistically significant at univariate analysis. On multivariate analysis only the previous medical management was statistically significant (p = 0.017). Conclusions The orchiectomy rate was very high in our cohort. The previous medical management was the only significant predictive factor of orchiectomy on multivariate analysis. Our findings demonstrated that the delay in diagnosis is the determining factor in testicular loss in our context.

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“…Previous studies have reported associations between transfer of patients to tertiary units and increased risk of orchidectomy, 17,18 and adherence to the RCS recommendations should reduce the delay in definitive management. Reducing the number of urgent transfers for suspected testicular torsion also minimises the burden on emergency ambulance services in having to undertake these journeys (which entail additional risks to patient, ambulance crew and general public) along with the non-availability of the ambulance for other emergencies at a time of increasing demand.…”

Section: Discussionmentioning

confidence: 99%

Does the source of referral affect outcomes for paediatric testicular torsion?

Peeraully

Jancauskaite

Dawes

et al. 2019

annals

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Introduction This single centre study retrospectively analysed the intraoperative findings relative to source of referral for emergency scrotal explorations performed in a tertiary level paediatric surgery department. Methods All patients who underwent emergency scrotal exploration under the care of paediatric surgeons in our unit between April 2008 and April 2016 were identified. Clinical data were obtained from contemporaneous records. Results Over the 8-year study period, 662 boys underwent emergency scrotal exploration: 6 (1%) were internal referrals, 294 (44%) attended our emergency department (ED) directly, 271 (41%) were referred from primary care and 91 (14%) were transferred from other hospitals. Excluding procedures in neonates, testicular torsion was present in 100 cases (15%). Testicular detorsion with bilateral 3-point testicular fixation was performed in 66 (66%) and orchidectomy with contralateral fixation in 34 (34%) where the torted testis was non-viable intraoperatively. The orchidectomy rate in the presence of torsion was 23% in ED referrals (12/52), 43% in primary care referrals (12/28) and 50% for transfers (10/20). The difference in rates between ED referrals and patients transferred from other hospitals was significant (p=0.026). There was no significant difference in median age between any of the groups (p=0.10). Conclusions Boys undergoing emergency scrotal exploration had a higher orchidectomy rate when transferred from other hospitals to our unit. This difference was statistically significant when compared with boys presenting directly to our ED. This supports advice from The Royal College of Surgeons of England for undertaking paediatric scrotal explorations in the presenting hospital when safe to do so rather than delaying the care of these patients by transferring them to a tertiary paediatric surgical unit.

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Indicators and outcomes of transfer to tertiary pediatric hospitals for patients with testicular torsion

Cited by 29 publications

References 17 publications

Presentation delay, misdiagnosis, inter-hospital transfer times and surgical outcomes in testicular torsion: analysis of statewide case series from central Brazil

Presentation delay, misdiagnosis, inter-hospital transfer times and surgical outcomes in testicular torsion: analysis of statewide case series from central Brazil

Predictive factors for orchiectomy in adult’s spermatic cord torsion: a case‐control study

Does the source of referral affect outcomes for paediatric testicular torsion?

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