Presentation delay, misdiagnosis, inter-hospital transfer times and surgical outcomes in testicular torsion: analysis of statewide case series from central Brazil

Abstract

Purpose: To estimate statewide presentation delay, misdiagnosis rate, inter-hospital transfer times and testicular salvage for testicular torsion patients treated in our state's public health system. Patients and Methods: Case series of consecutive testicular torsion patients treated in our state's public health system between 2012-2018. Predictors included presentation delay (time from symptoms to first medical assessment), facilitie's level-of-care (primary, secondary, tertiary), first diagnosis (torsion, epididymitis, other), Doppler-enhanced ultrasound request (Doppler-US) and inter-hospital transfer times, with surgical organ salvage as the main response. We used Bayesian regression to estimate the effect of first examining facilitie's level-of-care, first diagnosis, and Doppler-US on transfer time. Results: 505 patients were included, most (298, 59%) with presentation delay >6 hours. Misdiagnosis at first examining facility raised transfer time from median 2.8 to 23.4 (epididymitis) and 37.9 hours (other) and lowered testicular salvage rates from 60.3% (torsion) to 10.7% (epididymitis) and 18.3% (other). Doppler-US had negligible effects on transfer time once controlling for misdiagnosis in the regression model. Although organ salvage in patients presenting before 6 hours at the tertiary facility was high (94.6%, and about 20% lower for those presenting at lower levels-of-care), the overall salvage rate was more modest (46%). Conclusion: Our low overall testicular salvage rates originated from a large proportion of late presentations combined with long transfer times caused by frequent misdiagnoses. Our results indicate that efforts to improve salvage rates should aim at enhancing populationwide disease awareness and continuously updating physicians working at primary and secondary levels-of-care about scrotal emergencies.

Demographic, clinical, and socioeconomic factors associated with delayed diagnosis and management of pediatric testicular torsion in West China: a retrospective study of 301 cases in a single tertiary children’s hospital

“…Our findings indicated that it was very important to strengthen the public awareness of TT, and effects must be conducted to continuously re-educate and update physicians working at primary and secondary healthcare units. This finding was consistent with two latest similar studies from India and Brazil [ 7 , 8 ], which indicated that improvement of accurate diagnosis of TT in primary and secondary healthcare units was greatly needed around the world.…”

“…A large number of studies reported that, worldwide, the delayed diagnosis and management of TT was quite common, and a relatively high proportion of TT patients proven to be delayed even in tertiary hospitals [ 7 , 8 ]. Aaron P. Bayne et al [ 1 ] and Christopher E. Bayne et al [ 9 ], in the United States, and Ekici et al [ 10 ] in Turkey, have investigated the clinical, socioeconomic and other factors associated with delayed management of TT, while there have no relevant reports among Chinese populations.…”

Clinical characteristics of testicular torsion and factors influencing testicular salvage in children: A 12-year study in tertiary center

“…TT is a urology emergency; therefore, sociological characteristics, such as tertiary hospital location, were also considered. Univariate and multivariate logistic regression analyses in the current study showed that only patients who visited the tertiary facility shortly after symptom onset had a higher salvage rate, which was similar to research in Brazil[ 19 ]. Tertiary hospitals often have better Doppler ultrasound equipment, more experienced ultrasound diagnosticians, and urologists at higher levels, which results in lower rates of misdiagnosis.…”

Çocuklarda Testis Torsiyonu: 10 Yıllık Retrospektif Bir Çalışma

“…be saved if the appropriate intervention could be performed in the first 6 hours. Extreme testicular atrophy has been found due to torsions that exceeded 360 degrees and lasted longer than 24 hours (20). According to the results, orchiectomy was not performed in 46.4% patients and the testes could be saved by detorsion.…”