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Acute testicular pain in children: collaboration in timely management
Kathryn E Ford1, Lillian L R Cooper, Sam Thenabadu
1aDepartment of Paediatric Surgery, King's College Hospital bGeneral Surgery, The Royal Free Hospital, London cAccident and Emergency Department Princess Royal University Hospital, Kent, UK.
Insights
Prompt surgical evaluation is crucial for pediatric acute scrotal pain. Surgeons reviewed patients faster than emergency department doctors, highlighting the need for direct, fast-track referrals to expedite care for potential testicular torsion.
Area of Science:
- Pediatric Urology
- Emergency Medicine
- Surgical Assessment
Background:
- Acute scrotal pain in children necessitates urgent urological evaluation.
- Prompt diagnosis and management are critical to prevent testicular damage, especially in cases of torsion.
Purpose of the Study:
- To compare the assessment times of Emergency Department (ED) doctors and surgeons for pediatric patients with acute scrotal pain.
- To identify potential delays in the evaluation process within the ED.
Main Methods:
- Retrospective observational study conducted in a district general hospital's ED over two years.
- Analysis of 205 pediatric cases presenting with testicular pain.
- Comparison of review times based on practitioner (ED doctor vs. surgeon) and referral pathway (direct from triage vs. via ED doctor).
Main Results:
- Surgeons provided quicker reviews than ED doctors for patients referred directly from triage (P=0.019).
- Referral directly to surgeons from triage resulted in more timely reviews compared to those initially seen by an ED doctor (P<0.0001).
- Out of 205 children, 48 were diagnosed with testicular torsion in the ED.
Conclusions:
- A direct fast-track referral system to surgeons is essential in the ED.
- Streamlining the referral process can prevent delays in the definitive management of pediatric acute scrotal pain.
- Optimizing surgical consultation times is key for preserving testicular viability.
Abstract:
Acute scrotal pain in a child is a urological emergency. Surgeons should be involved early and exclude torsion promptly, often by surgical exploration. This short report compares the time taken by different medical practitioners [Emergency Department (ED) doctors and surgeons] to assess children presenting to the ED with acute scrotal pain. A retrospective observational study was carried out in a district general hospital ED over a 2-year period. A total of 205 children presented with testicular pain, 48 of whom were clinically diagnosed with torsion in the ED. Surgeons reviewed patients with testicular pain quicker than ED doctors when they were referred directly from triage (P=0.019). Overall, review by a surgeon was more timely if the patient was referred directly from triage rather than after referral by the ED doctor (P<0.0001). A direct fast-track referral system to surgeons is needed in the ED to prevent unnecessary delays in definitive management of patients with testicular pain.
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