A Two-Year experience with bedside emergency ultrasonography for acute scrotal pain in the emergency department

Abstract

Study objectives: Acute scrotal pain is a modestly common emergency department (ED) complaint. Because of increasing limitations in imaging services, emergency physicians are using their bedside ultrasonographic skills for more difficult diagnoses such as scrotal pain. We describe the practice pattern and sensitivity of bedside ED ultrasonography performed by emergency physicians for acute scrotal pain during a 2-year period. Methods: This was a retrospective quality assurance study performed at an urban ED with a residency program, an active ultrasonographic education program including an emergency ultrasonographic fellowship. The facility has an annual census of 75,000 patients. The ED quality assurance log was searched for all scrotal ultrasonographic studies performed for complaints of scrotal pain presenting within 24 hours of onset. A 12-MHz linear array transducer with pulsed wave and power Doppler capability was used to scan the scrotum. Diagnoses were verified by radiology ultrasonography, nuclear medicine, surgical evaluation, and patient follow-up. Descriptive statistics, sensitivity, and specificity with 95% confidence intervals (CIs) were calculated. Results: Eight emergency physicians performed a total of 146 scrotal ultrasonographic studies. Comparison with follow-up data with emergency physician ultrasonographic results yielded a sensitivity of 95% (95% CI 0.78% to 0.99%) and a specificity of 94% (95% CI 0.72% to 0.99%). Diagnoses included 14 (10%) testicular torsions, 41 (28%) cases of epididymitis, 16 (11%) cases of orchitis, 6 (4%) testicular fractures from trauma, 8 (6%) hernias presenting as acute scrotal pain and swelling, 21 (14%) hydroceles without other pathology, 7 (5%) cases of torsion of the appendix testes, 9 (6%) scrotal infections including Fournier's gangrene, and 24 (16%) normal examinations on which no pathology was noted. Conclusion: Emergency physicians using bedside emergency ultrasonography encounter a variety of causes of acute scrotal pain and are accurate in their diagnosis compared with traditions imaging and surgical services. Most important, they appear able to differentiate between surgical emergencies such as testicular torsion and other etiologies that require medical or supportive treatment. Study objectives: Acute scrotal pain is a modestly common emergency department (ED) complaint. Because of increasing limitations in imaging services, emergency physicians are using their bedside ultrasonographic skills for more difficult diagnoses such as scrotal pain. We describe the practice pattern and sensitivity of bedside ED ultrasonography performed by emergency physicians for acute scrotal pain during a 2-year period. Methods: This was a retrospective quality assurance study performed at an urban ED with a residency program, an active ultrasonographic education program including an emergency ultrasonographic fellowship. The facility has an annual census of 75,000 patients. The ED quality assurance log was searched for all scrotal ultrasonographic studies performed for complaints of scrotal pain presenting within 24 hours of onset. A 12-MHz linear array transducer with pulsed wave and power Doppler capability was used to scan the scrotum. Diagnoses were verified by radiology ultrasonography, nuclear medicine, surgical evaluation, and patient follow-up. Descriptive statistics, sensitivity, and specificity with 95% confidence intervals (CIs) were calculated. Results: Eight emergency physicians performed a total of 146 scrotal ultrasonographic studies. Comparison with follow-up data with emergency physician ultrasonographic results yielded a sensitivity of 95% (95% CI 0.78% to 0.99%) and a specificity of 94% (95% CI 0.72% to 0.99%). Diagnoses included 14 (10%) testicular torsions, 41 (28%) cases of epididymitis, 16 (11%) cases of orchitis, 6 (4%) testicular fractures from trauma, 8 (6%) hernias presenting as acute scrotal pain and swelling, 21 (14%) hydroceles without other pathology, 7 (5%) cases of torsion of the appendix testes, 9 (6%) scrotal infections including Fournier's gangrene, and 24 (16%) normal examinations on which no pathology was noted. Conclusion: Emergency physicians using bedside emergency ultrasonography encounter a variety of causes of acute scrotal pain and are accurate in their diagnosis compared with traditions imaging and surgical services. Most important, they appear able to differentiate between surgical emergencies such as testicular torsion and other etiologies that require medical or supportive treatment.