374 - Orchiectomy Rates Between Typical and Atypical Presentations of Testicular Torsion

Poster Number: 374
Publication Number: 374.312

Joseph B. Gallagher, Connecticut Children's Medical Center, Hartford, CT, United States; Sharon Smith, Connecticut Children's Medical Center/UConn, Canton, CT, United States

Background: Testicular Torsion (TT) is a true emergency seen in Pediatric Emergency Departments throughout the world. The typical presentation involves acute onset of testicular/groin pain or swelling. Atypical presentations occur when patients do not have scrotal symptoms and present with abdominal pain. A delay in diagnosis of TT often leads to worse outcomes including loss of the testicle.

Objective: The purpose of this study is to compare time to recognition and testicular outcomes between boys who present with typical versus atypical presentations.

Design/Methods: This retrospective cohort study audited charts for all boys with discharge diagnoses of TT who were initially evaluated in the pediatric emergency department from January 1, 2016- December 31, 2020. Demographic characteristics, time factors (including time of: Symptom onset, ED arrival, Ultrasound Exam Begun, Ultrasound Results, OR Arrival Wheels In), surgical outcomes, presenting symptoms and physical exam, prior visits or transfer, and medical history were collected. Boys were categorized into Typical (any scrotal chief complaint or symptoms in history) or Atypical (no scrotal or groin complaints) groups. Additionally, age, race/ethnicity, BMI, weight, time to presentation, initial medical history, and physical examination factors were collected.

Results: Of the 150 patients who met inclusion criteria, 46% W, 21% black, 27% Hispanic; mean age 13.7 years (SD 2.3). There were 9 presentations deemed as Atypical.  The two groups were similar in age, BMI, and race.  The overall orchiectomy rate was 20%, with 78% in atypical group vs. 17% in typical group, p value < 0.05. Median duration of symptoms for Atypical was 44.4 hrs vs. 7.7 hrs (p < 0.05). Abdominal pain was found to be present in 41% of all TTs and associated vomiting in 37% of cases. All Atypical presentations had previously been seen by providers and torsion was not identified. Two cases had no genital exam at initial evaluation. Median duration of symptoms for orchiectomy was 47.1hrs vs orchiopexy 6.6 hrs.Conclusion(s): Atypical presentations of TT were associated with a significantly higher rate of orchiectomy than typical presentations.  Abdominal pain alone was the most common atypical presentation and occurred in 41% of all boys with TT. External genital exams should be performed in all cases of pediatric abdominal pain.
CV_GallagherCV_Gallagher.pdf