Pediatric testicular torsion: does patient transfer affect time to intervention or surgical outcomes at a rural tertiary care center?

Abstract

Background Testicular torsion (TT) is a urologic emergency that requires prompt surgical intervention. In rural Appalachia, patients are often transferred from surrounding communities due to lack of urologic care. We hypothesized that those transferred would have delayed intervention and higher rates of orchiectomy when compared to those who presented directly to our hospital. Methods We performed a retrospective review of patient charts with an ICD-9 diagnosis of TT from 2008 to 2016. Patients met inclusion criteria if diagnosis was confirmed by operative exploration. We compared rate of testicular loss and time until surgical intervention between groups. Results Twenty-three patients met inclusion criteria (12 transferred, 11 direct). Patient demographics did not significantly differ between groups. Transferred patients had a higher orchiectomy rate (33% v 22%, p = 0.41) although this was not statistically significant. Time to surgery from symptom onset was significantly longer in those transferred (12.9 h) compared to those not transferred (6.9 h, p = 0.02). Distance of transfer was not correlated with time of delay (r 2 = 0.063). Conclusions Transferred patients with TT have numerically higher rates of orchiectomy which may reach significance in an appropriately powered study, and relative delays in surgical intervention. This study highlights the need for improved access to urologic care in rural areas.

Point-of-care ultrasonography for the diagnosis of testicular torsion: a practical resident curriculum

“…In smaller centres, this delay may be even longer because of the need to call the ultrasonography technologist in from home or to transfer patients to larger centres. Overholt and colleagues 5 found that in cases in which the patient required transfer for Doppler ultrasonography, there was a 6-hour delay to treatment. Such delays may lead to delays in definitive management and increased rates of testicular loss.…”

Factors Determining Testicular Torsion and Consequent Orchiectomy in Pediatric Patients Presenting With Scrotal Pain

“…Nonspecific symptoms such as inguinal swelling and pain, scrotal swelling, abdominal pain, and nausea or vomiting might delay the management of TT beyond 6 hours. 2,13,19,38 We attributed the good outcomes in our patients with TT to undergoing surgery shortly beyond 6 hours due to the good hospital access, comprehensive population coverage, and short waiting times, as well as prompt urology consultation. 40 Research has evaluated the predictors of TS in children with TT, 12,17 and we identified several risk factors associated with orchiectomy in children with TT in a multivariate analysis, including a longer interval between SP onset and PED arrival, 13,36,37 absent TUBF, 1,3,7,8,16,17,[31][32][33][34] interval between SP onset and surgery of more than 24 hours, 2,7,8,16 and a greater degree of TT.…”

“…This is different from previous reports. [36][37][38] Additional large studies of children with TT are required to confirm these results.…”

Impact of Distance From the Hospital and Patient Transfer on Pediatric Testicular Torsion Outcomes

“…Few studies have addressed the association between testicular torsion and distance from the hospital where treatment is performed and transfer from an outside hospital [2,6,8,9,[15][16][17]. Romao and colleagues' study of 1,713 patients with testicular torsion reported that distance traveled and transfer were not associated with outcomes [17].…”

“…With a sensitivity of 89-100% and a specificity of 69-99%, an US is readily available, noninvasive, and has a low cost [13]. A patient's distance from the hospital where he will be undergoing treatment for testicular torsion and transfer from an outside facility are two additional components that may impact whether the testis is saved [2,6,8,9,[15][16][17]. However, the extant literature varies in importance of these factors predicting whether a patient will undergo an orchiectomy.…”