Missed Torsion of the Spermatic Cord: A Common yet Underreported Event

To describe the incidence of missed diagnosis and delayed presentation in children with testicular torsion, and to identify associated risk factors.

The medical records of all children over 1 month of age diagnosed with testicular torsion between 2008 and 2014 were reviewed. Data pertaining to patient characteristics and treatment outcome were collected. Orchiectomy was categorized as caused by either delayed presentation or missed diagnosis. Logistic regression analyses were used to evaluate the association between patient characteristics and treatment outcome.

The study cohort included 100 children, 40 of whom underwent orchiectomy. Twenty-eight patients arrived with delayed presentation, and 12 were incorrectly diagnosed. On univariable logistic regression analyses, young age, long duration of pain, and prior community clinic examination were significantly associated with orchiectomy. Similarly, these variables were associated with delayed presentation and missed diagnosis when compared with the orchiopexy group. On multivariable analysis, young age and long duration of pain remained significant predictors of orchiectomy. Doppler ultrasound was performed in 70 patients; 7 of 70 ultrasounds were incorrectly diagnosed. Young age was associated with missed sonographic diagnosis, whereas ultrasound performer (senior radiologist vs resident) and time of the day were not.

Missed diagnosis may account for up to 12% of orchiectomy cases. Younger age and prior community clinic examination increase the risk of incorrect diagnosis. Doppler ultrasound should be used with discretion and its results interpreted cautiously.