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

Abstract

ObjectivesTesticular torsion (TT) is a pediatric surgical emergency that requires prompt treatment. This study investigated the feasibility of point‐of‐care ultrasound (POCUS) for diagnosing TT in the pediatric emergency department (ED).MethodsWe retrospectively reviewed the medical records of patients, aged 18 years or younger, who visited a university‐affiliated hospital pediatric ED with acute scrotal pain without trauma history and underwent diagnostic ultrasounds between January 2010 and October 2022.ResultsThis study included 731 patients (median age: 9 years), Of these, 315 (43%) were in the POCUS‐performed group: 188 in the POCUS‐only group, and 127 in the POCUS‐and‐RADUS group. The other 416 patients (56.9%) were in the RADUS‐only group. In total, 45 patients (6.2%) were diagnosed with TT (19 in the POCUS‐performed group and 26 in the RADUS‐only group). The sensitivity, specificity, and positive and negative predictive values of POCUS for diagnosing TT were 94.7%, 92.9%, 46.2%, and 99.6%, respectively. The median time to perform POCUS was shorter than RADUS (23 versus 61 minutes, P < .001). The POCUS‐performed group had a shorter ED length of stay than the RADUS‐only group (93 versus 170 minutes, P < .001). Among the patients diagnosed with TT, performing POCUS first did not significantly delay the ED process, including time to operation (250 versus 205 minutes, P = .142).ConclusionsFor patients with acute scrotal pain, evaluation performed by pediatric emergency physicians using POCUS performs well in screening TT, and can decrease length of stay in the ED.

Testicular Torsion with Intact Blood Flow: A Point of Care Ultrasound Case-Series

“…A subsequent meta-analysis found that POCUS had pooled sensitivity and specificity of 98.4% and 97.2% for testicular torsion [12]. Scrotal POCUS can be performed an average of 38-73 minutes before radiology performed ultrasound [11][12][13], has been shown to decrease PED length of stay by 77 minutes [13], and to decrease time to orchiopexy by over an hour [14].…”

Updates on the clinical integration of point-of-care ultrasound in pediatric emergency medicine

“…Thus, several studies have evaluated the implementation of POCUS pathways for acute scrotal pain in the pediatric ED. Park et al [79 ▪ ] performed a retrospective analysis of their POCUS pathway for acute scrotal pain, and found that patients in the POCUS group had a shorter ED length of stay (EDLOS) (93 vs. 170 min, P < 0.001), as well as high test sensitivity and specificity (94.7% and 92.9%). Similarly, Koppel et al [80] retrospectively compared patients who underwent POCUS vs. radiology US (RADUS) for testicular torsion; those in the POCUS group had a shorter time from arrival to orchidopexy (121 vs. 184, P = 0.036), and shorter EDLOS.…”