Diagnostic accuracy of point-of-care ultrasound for paediatric testicular torsion: a systematic review and meta-analysis

Abstract

BackgroundPrevious studies have examined the utility of ultrasonography performed by radiologists for diagnosing paediatric testicular torsion. While point-of-care ultrasound (POCUS) is used in paediatric emergency medicine, its diagnostic accuracy is still unknown.ObjectivesThe present systematic review and meta-analysis aimed to clarify the accuracy of POCUS in diagnosing testicular torsion in children.MethodsFollowing the Preferred Reporting Items for Systematic Review and Meta-analysis of Diagnostic Test Accuracy guidelines, a systematic review was performed using the indices of MEDLINE, EMBASE plus EMBASE classics, PubMed and the Cochrane database from inception to November 2020. Any study investigating the diagnostic accuracy of POCUS for paediatric testicular torsion was extracted. The primary outcome was the assessment of the diagnostic accuracy of POCUS for paediatric testicular torsion. The pooled sensitivity and specificity were calculated. Quality analysis was conducted using Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2).ResultsFour studies enrolling 784 patients in total were included. The pooled sensitivity, specificity, and positive and negative likelihood ratios of POCUS were 98.4% (95% CI: 88.5% to 99.8%), 97.2% (95% CI: 87.2% to 99.4%), 34.7 (95% CI: 7.4 to 164.4) and 0.017 (95% CI: 0.002 to 0.12), respectively. Risk-of-bias assessment using QUADAS-2 revealed that two of the studies had a high risk of bias in patient selection.ConclusionThe present systematic review and meta-analysis showed that POCUS had high sensitivity and specificity for identifying testicular torsion in paediatric patients although the risk of bias was high in the studies analysed.

Point-of-Care Ultrasound for the Diagnosis of Pediatric Testicular Torsion

“…Accuracy analyses were deferred because of the small sample size; however, our study does demonstrate how scrotal POCUS performed by PEM physicians can be used to rule in testicular torsion in cases of pediatric acute scrotum. These findings are consistent with accuracy analyses recently published in a meta-analysis reviewing the accuracy of pediatric testicular POCUS performed by urology and PEM physicians alike 6,7 …”

“…These findings are consistent with accuracy analyses recently published in a meta-analysis reviewing the accuracy of pediatric testicular POCUS performed by urology and PEM physicians alike. 6,7 No isolated history, symptom, or physical examination finding can determine the likelihood of acute testicular torsion in the pediatric population; however, there are scores extracted from the adult populations not yet validated in children. 8,9 By convention, RADUS is considered the imaging criterion standard for the diagnosis of acute testicular torsion and can be used to triage patients arriving to the emergency department with an acute scrotum.…”

Clinical risk factors for testicular torsion and a warning against falsely reassuring ultrasound scans: a 10-year single-centre experience

“…A study from 2020 found that scrotal point-of-care US (POCUS) performed by paediatric emergency physicians had 100% sensitivity in detecting TT and US results were generated 73 min before radiology department results 27. The systematic review and meta-analysis from 2022 demonstrated that POCUS had high sensitivity and specificity in identifying TT in paediatric patients 28. However, authors emphasised that the quality of the evidence of the studies analysed was moderate owing to a high risk of bias in patient selection and heterogeneity.…”

Implementing Point‐of‐Care Ultrasound for Acute Scrotal Pain in the Pediatric Emergency Department

“…3,11 To reduce unnecessary delays in ED, the use of pointof-care ultrasound (POCUS), which can be quickly performed by the ED physician, has been increasing and being investigated recently in the same manner as other pediatric emergencies, including intussusception, acute appendicitis, and infantile hypertrophic pyloric stenosis. [12][13][14][15][16][17] Mori et al reported high sensitivity and specificity for diagnosing TT using POCUS. 13 Koppel et al reported advantages, such as a shortened ED length of stay (EDLOS), when using POCUS as a confirmatory test for surgery.…”

“…[12][13][14][15][16][17] Mori et al reported high sensitivity and specificity for diagnosing TT using POCUS. 13 Koppel et al reported advantages, such as a shortened ED length of stay (EDLOS), when using POCUS as a confirmatory test for surgery. 12 To date, studies on the diagnostic performance of POCUS, performed by pediatric emergency physicians, are limited.…”