Time delays in presentation and treatment of acute scrotal pain in a provincial hospital

Johnston, John W.; Larsen, Peter; El‐Haddawi, Falah; Fancourt, Michael; Farrant, Glen J.; Gilkison, William; Kyle, Stephen; Mosquera, Damien

doi:10.1111/ans.12601

Cited by 15 publications

(13 citation statements)

References 12 publications

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“…In addition to in-hospital time (T2), we found that time between ultrasonography and operating theatre (T4) were also longer in the orchiectomy group (p < .05). These results suggest that the use of ultrasound delays time of operation and increases the rate of orchiectomy, which is in line with data in literature [9,10,28]. As in-hospital time is an important factor in testicular survival, scoring systems like the TWIST score seem to be interesting to shorten the time to surgery [21].…”

Section: Influence Of Prehospital and In-hospital Times On Testicularsupporting

confidence: 88%

“…Castañeda-S anchez et al [31] reported that inhospital times were 5.57 h in the orchiectomy group and 3.6 h in the salvaged group. We also found that in-hospital times (T2) were longer in the orchiectomy group (4.1 h) than in the salvaged group (2.6 h) as described in literature [9,28].…”

Section: Influence Of Prehospital and In-hospital Times On Testicularsupporting

confidence: 83%

“…For patients with nonviable testis, the median prehospital time in our cohort was 48 h (IQR: 15.4-138 h). Median symptom duration in orchiectomy group was 24 h in the study of Johnston et al [9], 46 h in the study of Pogorelic et al [27] and 90 h in the study of Yang et al [15].…”

Section: Influence Of Prehospital and In-hospital Times On Testicularmentioning

confidence: 94%

“…In our cohort, 28.4% of cases resulted in orchiectomy. In the literature, this rate varies between 20% and 60% with a mean of 39% [8][9][10].…”

Section: Cohort Analysismentioning

confidence: 99%

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Impact of treatment delays on outcome of acute testicular torsion: a 15-year retrospective study

Steeman

Ngatchou

Ramadan

et al. 2021

Acta Chirurgica Belgica

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Introduction: Preservation of the testicle is directly associated with the duration of torsion. The aim in this retrospective study was to identify factors that influence pre-and in-hospital times and measure the extent to which these times affect testicle survival. Patients and methods: A retrospective review of 116 patients who underwent exploration for testicular torsion between 2000 and 2015. Patients were divided into orchiectomy and salvaged testicle groups. Times in patient management and clinical features were compared with Mann-Whitney, chi-squared, and Fisher exact tests. Multivariate logistical regression was used to identify independent factors associated with orchiectomy. Results: The median prehospital time of 48 h (15.4-138 h) in the orchiectomy group was longer than the 2.4 h (1.6 h-5.2h) in the salvaged group. Patients examined by a general practitioner (GP) prior to presenting at hospital had a median prehospital time of 48 h, compared to 3 h for patients not examined before presentation at hospital. In-hospital times between admission and operation room, as well as times between ultrasonography and operation room, were also longer in the orchiectomy group. Previous GP consultation (OR ¼ 27.26, 95% CI 2.32-320.59, p ¼ .009), prehospital time (OR ¼ 1.04, 95% CI 1.01-1.07, p ¼ .003) and nausea (OR ¼ 9.25, 95% IC 1.33-64.52, p ¼ .025) were independent predictive factors associated with orchiectomy. Conclusion: Prehospital time was a determining factor in orchiectomy. For each extra hour of prehospital delay, the risk of orchiectomy increased by 4%. The rate of orchiectomy was higher among patients who first consulted a GP.

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Section: Influence Of Prehospital and In-hospital Times On Testicularsupporting

confidence: 88%

Section: Influence Of Prehospital and In-hospital Times On Testicularsupporting

confidence: 83%

Section: Influence Of Prehospital and In-hospital Times On Testicularmentioning

confidence: 94%

“…In our cohort, 28.4% of cases resulted in orchiectomy. In the literature, this rate varies between 20% and 60% with a mean of 39% [8][9][10].…”

Section: Cohort Analysismentioning

confidence: 99%

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Impact of treatment delays on outcome of acute testicular torsion: a 15-year retrospective study

Steeman

Ngatchou

Ramadan

et al. 2021

Acta Chirurgica Belgica

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“…1,4 It is recognised that there is a 4-8-hour window before significant ischaemic damage occurs in testicular torsion, 5,6 resulting in morphological changes in testicular histopathology and impaired spermatogenesis. 6,7 Delayed exploration leads to increased orchidectomy rates 6,8 and it would therefore follow that patients being transferred from regional hospitals to tertiary paediatric surgical centres are potentially at increased risk of testicular loss. 9 In the UK, this has resulted in the recommendation that these transfers should occur as an exceptional circumstance and that exploration should be undertaken in the presenting hospital.…”

mentioning

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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Impact of on-hours versus off-hours admission on outcome in pediatric patients with testicular torsion

Zvizdic,

Jonuzi,

Glamoclija

et al. 2025

The American Journal of Emergency Medicine

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Time delays in presentation and treatment of acute scrotal pain in a provincial hospital

Abstract: Delay from the time of testicular pain until surgical exploration is important for the chances of testicular salvage and is made up mostly of pre-hospital delays. Patients under the age of 14 had longer delays pre-hospital.

Cited by 15 publications

References 12 publications

Impact of treatment delays on outcome of acute testicular torsion: a 15-year retrospective study

Impact of treatment delays on outcome of acute testicular torsion: a 15-year retrospective study

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

Impact of on-hours versus off-hours admission on outcome in pediatric patients with testicular torsion

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