Management of the acute scrotum in children

The study investigates the hypothesis that testicular torsion is over-diagnosed by emergency department (ED) doctors. Diagnoses made by ED doctors are compared with those made by a surgical registrar or specialist and the review outcome by a surgical registrar or specialist on diagnosis and management is evaluated.

Medical records of all boys up to the age of 14 years who presented with an acute scrotum to the ED at The Canberra Hospital between October 1995 and October 2000 were retrospectively reviewed.

A total of 182 boys presented to the ED on 190 occasions; mean age of presentation was 10.1 years and mean time from onset of pain to presentation was 27.6 h. Ninety (47.4%) patients had a torted testicular appendage, 23 (12.1%) had testicular torsion and 12 (6.3%) had epididymitis or orchitis. Eighty-one patients underwent surgery, in whom 61 were excluded from having testicular torsion. Testicular torsion was suspected by ED doctors in 57.5% of patients, by registrars in 35.4% and by specialists in 17.7%. Overall, the correct diagnosis was made by ED doctors in 39% of patients, by registrars in 53% and by specialists in 76%.

Less experienced examiners suspect testicular torsion more frequently than surgical registrars or specialists. Review of the patient by an experienced examiner should allow for more accurate initial diagnoses and spare some children unnecessary surgical procedures.