Impact of Referral Pathways on Paediatric Testicular Torsion Outcomes in Southern Chile

Testicular torsion (TT) is a critical condition caused by spermatic cord twisting, which can result in irreversible testicular damage without timely intervention. In Chile, centralised healthcare and significant geographic barriers can delay treatment for TT, which potentially worsens outcomes. This study evaluates the impact of referral status on orchiectomy rates among paediatric TT cases treated at two hospitals in Southern Chile.

A cross-sectional analysis was conducted on TT cases in patients under 15 years. These patients were treated at Hospital Guillermo Grant Benavente and Hospital Las Higueras between January 2018 and January 2024. Data on demographics, symptom duration, referral status and treatment timelines were analysed using Wilcoxon rank-sum and Pearson's Chi-squared tests, with significance set at p < 0.05.

Among 144 patients, 71% were referred from other facilities. Orchiectomy was performed in 44 cases, with a median symptom duration of 48 h, which was significantly longer than that of non-orchiectomy cases (5 h, p < 0.001). Referred patients showed a higher crude orchiectomy rate (35% vs. 20%; p = 0.064). However, in the multivariable analysis with adjusted age, hospital and symptom onset time, referral emerged as an independent predictor of orchiectomy (odds ratio (OR) = 3.68; 95% confidence interval (CI): 1.15-13.1; p = 0.035).

Referral delays in TT management correlate with increased orchiectomy rates. Enhancing specialist access and referral protocols is crucial to reducing treatment delays and improving outcomes in regions with dispersed healthcare services.