Testicular pain pathway in children: Investigating where missed torsion occurs most often

Bastianpillai, Christopher; Haddad, Sami; Green, J.

doi:10.1016/s1569-9056(18)31535-5

Cited by 3 publications

(5 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The whole pediatric ED in the United Kingdom can be considered to be managing torsion well, and these data are backed up by previous studies. 15,16 In particular, a recent study by Bastianpillai et al 15 (2020), who showed that EDs are often highly accurate in their diagnoses of torsion and have a vital role as they manage to exclude over 50% of children presenting with scrotal pain, quickly and clinically very accurately before a specialist surgical opinion is sought and the most significant factor leading to orchidectomy is due to late presentation by the patient.…”

Section: Discussionmentioning

confidence: 99%

Supporting a Learning System in Pediatric Emergency Pathways

et al. 2022

View full text Add to dashboard Cite

Background: Scrotal pain is a common presentation to the emergency department requiring prompt investigation and management to identify testicular torsion and increase the opportunity for testicular salvage. Using national data obtained from the NHS Improvement, we aim to identify key suboptimal areas in the acute diagnosis and management of testicular torsion with a view to learning from these and improving outcomes.Methods: A freedom of information request was made to all 134 hospital groups in England and Wales that manage testicular torsion. Serious incidents experienced by these hospitals were analyzed to see whether those with pediatric emergency departments fared better than those without. In addition, a qualitative thematic analysis of the NHS Improvement National Reporting and Learning System database over a 12-year period (2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016)(2017)(2018)(2019) was undertaken, to identify common themes associated with orchidectomies and "near-miss" events in the pediatric population.Results: Three hundred four patient safety incidents were returned and divided into 62 orchidectomies and 242 near-miss events. The most common factor in the orchidectomy group was individual factors (83.9%). Misdiagnosis of symptomatic testicle was not significant when comparing ED to specialist surgeons (odds ratio = 1.46, P = 0.3842). Atypical presentation resulting in orchidectomy was significant when comparing ED with specialists (odds ratio = 6, P = 0.0355). Near-miss events, not leading to orchidectomy, are often due to a wider variety of factors. A Mann-Whitney U test showed that there was no statistical significance in incidents when comparing general ED units caring for all ages with pediatric EDs in terms of incidents (U = 807.5, z = −1.124, P = 0.261).Conclusions: There is a need for education in ED about atypical presentation of testicular torsion and examination of scrotum in cases of lower abdominal pain. It is also vital that specialist teams are cognizant of the standard operating procedures relevant to scrotal pain and testicular within the organization and the wider clinical network. Finally, there should be a drive for annual collation of data in urology and ED units with regards to testicular torsion as patient safety incidents may be underreported.

show abstract

Section: Discussionmentioning

confidence: 99%

Supporting a Learning System in Pediatric Emergency Pathways

et al. 2022

View full text Add to dashboard Cite

show abstract

“…Looking at the current diagnostic pathway, there are a number of points where delays can occur, ranging from patient/carer appreciation of the problem to secondary care treatment ( Figure 2), and are common in many timesensitive pathways. [3][4][5] Is there a delay in the community?…”

Section: Optimising the Patient Pathwaymentioning

confidence: 99%

“…This concurs with a recent audit of missed torsions confirming that the longest delays occur before parents or the child access any medical care. 5 Who should make the initial secondary care assessment?…”

Section: Optimising the Patient Pathwaymentioning

confidence: 99%

“…EDs correctly discharged half of all paediatric patients presenting with scrotal pain with no resultant cases of missed torsion, thereby minimising the number of unnecessary onward referrals and speeding up the discharge from casualty. 5 Despite this, there are some proposed models of care where all patients with testicular pain are automatically referred directly to an on-call team, bypassing the ED.…”

Section: Optimising the Patient Pathwaymentioning

confidence: 99%

“…More importantly, the sensitivity of ultrasound is not 100%, which can lead to patients requiring delayed orchiectomy following an initially reassuring scan. 5,6 Should emergency assessment be bypassed?…”

Section: Should We Be Imaging?mentioning

confidence: 99%

See 2 more Smart Citations