Abstract
Introduction: Testicular torsion (TT) is a common emergency that warrants immediate exploration to prevent infertility or testicular loss. To improve diagnostic reliability, various scoring systems have been published. The aim of this study was to evaluate and validate different testicular torsion scores in a large cohort of children with acute scrotum.Methods: Retrospective analysis of all male children that were admitted for acute scrotum at the Pediatric Surgery Department of the Altonaer Kinderkrankenhaus and University medical Center Hamburg-Eppendorf from 01/2013 to 03/2019. Two testicular torsion scores (Boettcher Alert Score, Testicular Workup for Ischemia and Suspected Torsion Score) were applied to all data sets. Furthermore, an artificial intelligence (AI)-based score was developed and compared to the two current scores.Results: In total, 460 boys were included in the study. Of those, 48 (10.4%) had TT. Children with TT suffered most often from short duration of pain, nausea and vomiting, high riding testicle and absent cremasteric reflex. The BALS and the AI-based score had excellent predictive values and all patients with TT would have been detected.Conclusion: The BAL and the AI score show excellent predictive capabilities and may be used to identify all cases of TT in a pediatric population. The scores are easy to apply. As the BALS was slightly better, we advocate to use this score but to validate our findings in prospective multicenter studies.
Highlights
Testicular torsion (TT) is a common emergency that warrants immediate exploration to prevent infertility or testicular loss
Conclusive diagnosis is hampered by clinical overlap between the common reasons of acute scrotum [12]
The patients were selected from the hospital database using the ICD10 codes for acute scrotum including testicular torsion, testicular appendage torsion, epididymitis and idiopathic scrotal edema
Summary
Testicular torsion (TT) is a common emergency that warrants immediate exploration to prevent infertility or testicular loss. The aim of this study was to evaluate and validate different testicular torsion scores in a large cohort of children with acute scrotum. Testicular torsion is an immediate surgical emergency, without prompt intervention it results in an ischemia-reperfusion (IR) injury with subsequent infertility or testicular loss [1, 2]. Conclusive diagnosis is hampered by clinical overlap between the common reasons of acute scrotum [12]. Doppler ultrasonography in addition to clinical examination appears to be very useful. It provides excellent sensitivity of 85–100% and specificity of 75–100% [13,14,15]. It is very operator dependent with a relevant risk of false-negative results [16]
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