Clinical state of the paediatric acute scrotum in south-eastern Victoria

Sharman P. Tan Tanny, Naveen Wijekoon, Maurizio Pacilli, Ramesh M. Nataraja

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background: Acute scrotal pain is a common paediatric surgical presentation. Delays in treatment can result in testicular loss from torsion. It is unclear where delays occur. We aimed to investigate presentations with an acute scrotum to identify any potential areas of delay. Methods: We conducted a prospective study (April 2017–November 2018) of paediatric patients (<18 years) presenting with acute scrotal pain. Data collected included: patient demographics, history/examination findings, mode of presentation, clinical timeline details and outcomes. Results: A total of 107 acute scrotum presentations were identified: 58 (54.2%) testicular appendage torsion, 23 (21.5%) testicular torsion, 6 (5.6%) epididymo-orchidits and 20 (18.7%) other diagnoses. Median age at presentation was 11 years (4 months–16 years). Fifty-seven (53.3%) underwent emergency surgery, of whom 23 (40.4%) had testicular torsion, with 2 requiring orchidectomy. Median time from onset of symptoms to seeking medical opinion was 5.5 (0–135) h. Once assessed by a medical professional, the route to paediatric surgical review via general practitioner (GP) and local emergency department (ED) to paediatric ED was 4.84 (1.67–24.5) h; via GP to paediatric ED was 2.58 (0.75–25.5) h; via local ED to paediatric ED was 2.25 (1–7.75) h; and directly to paediatric ED was 0.45 (0–1.42) h. Conclusion: Delays in assessment and treatment of acute scrotal pain occur from the time parents are aware of symptoms to seeking medical opinion. Education to increase awareness may reduce time delays. GPs should refer patients directly to a paediatric ED. Local EDs should manage paediatric cases as per the local surgeons' skill base.

Original languageEnglish
Number of pages5
JournalANZ Journal of Surgery
DOIs
Publication statusAccepted/In press - 11 Sep 2019

Keywords

  • acute scrotum
  • epididymo-orchitis
  • paediatric
  • testicular appendage
  • testicular torsion

Cite this

@article{87ec6f2c32b3498c94cc347d7872d730,
title = "Clinical state of the paediatric acute scrotum in south-eastern Victoria",
abstract = "Background: Acute scrotal pain is a common paediatric surgical presentation. Delays in treatment can result in testicular loss from torsion. It is unclear where delays occur. We aimed to investigate presentations with an acute scrotum to identify any potential areas of delay. Methods: We conducted a prospective study (April 2017–November 2018) of paediatric patients (<18 years) presenting with acute scrotal pain. Data collected included: patient demographics, history/examination findings, mode of presentation, clinical timeline details and outcomes. Results: A total of 107 acute scrotum presentations were identified: 58 (54.2{\%}) testicular appendage torsion, 23 (21.5{\%}) testicular torsion, 6 (5.6{\%}) epididymo-orchidits and 20 (18.7{\%}) other diagnoses. Median age at presentation was 11 years (4 months–16 years). Fifty-seven (53.3{\%}) underwent emergency surgery, of whom 23 (40.4{\%}) had testicular torsion, with 2 requiring orchidectomy. Median time from onset of symptoms to seeking medical opinion was 5.5 (0–135) h. Once assessed by a medical professional, the route to paediatric surgical review via general practitioner (GP) and local emergency department (ED) to paediatric ED was 4.84 (1.67–24.5) h; via GP to paediatric ED was 2.58 (0.75–25.5) h; via local ED to paediatric ED was 2.25 (1–7.75) h; and directly to paediatric ED was 0.45 (0–1.42) h. Conclusion: Delays in assessment and treatment of acute scrotal pain occur from the time parents are aware of symptoms to seeking medical opinion. Education to increase awareness may reduce time delays. GPs should refer patients directly to a paediatric ED. Local EDs should manage paediatric cases as per the local surgeons' skill base.",
keywords = "acute scrotum, epididymo-orchitis, paediatric, testicular appendage, testicular torsion",
author = "{Tan Tanny}, {Sharman P.} and Naveen Wijekoon and Maurizio Pacilli and Nataraja, {Ramesh M.}",
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journal = "ANZ Journal of Surgery",
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Clinical state of the paediatric acute scrotum in south-eastern Victoria. / Tan Tanny, Sharman P.; Wijekoon, Naveen; Pacilli, Maurizio; Nataraja, Ramesh M.

In: ANZ Journal of Surgery, 11.09.2019.

Research output: Contribution to journalArticleResearchpeer-review

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T1 - Clinical state of the paediatric acute scrotum in south-eastern Victoria

AU - Tan Tanny, Sharman P.

AU - Wijekoon, Naveen

AU - Pacilli, Maurizio

AU - Nataraja, Ramesh M.

PY - 2019/9/11

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N2 - Background: Acute scrotal pain is a common paediatric surgical presentation. Delays in treatment can result in testicular loss from torsion. It is unclear where delays occur. We aimed to investigate presentations with an acute scrotum to identify any potential areas of delay. Methods: We conducted a prospective study (April 2017–November 2018) of paediatric patients (<18 years) presenting with acute scrotal pain. Data collected included: patient demographics, history/examination findings, mode of presentation, clinical timeline details and outcomes. Results: A total of 107 acute scrotum presentations were identified: 58 (54.2%) testicular appendage torsion, 23 (21.5%) testicular torsion, 6 (5.6%) epididymo-orchidits and 20 (18.7%) other diagnoses. Median age at presentation was 11 years (4 months–16 years). Fifty-seven (53.3%) underwent emergency surgery, of whom 23 (40.4%) had testicular torsion, with 2 requiring orchidectomy. Median time from onset of symptoms to seeking medical opinion was 5.5 (0–135) h. Once assessed by a medical professional, the route to paediatric surgical review via general practitioner (GP) and local emergency department (ED) to paediatric ED was 4.84 (1.67–24.5) h; via GP to paediatric ED was 2.58 (0.75–25.5) h; via local ED to paediatric ED was 2.25 (1–7.75) h; and directly to paediatric ED was 0.45 (0–1.42) h. Conclusion: Delays in assessment and treatment of acute scrotal pain occur from the time parents are aware of symptoms to seeking medical opinion. Education to increase awareness may reduce time delays. GPs should refer patients directly to a paediatric ED. Local EDs should manage paediatric cases as per the local surgeons' skill base.

AB - Background: Acute scrotal pain is a common paediatric surgical presentation. Delays in treatment can result in testicular loss from torsion. It is unclear where delays occur. We aimed to investigate presentations with an acute scrotum to identify any potential areas of delay. Methods: We conducted a prospective study (April 2017–November 2018) of paediatric patients (<18 years) presenting with acute scrotal pain. Data collected included: patient demographics, history/examination findings, mode of presentation, clinical timeline details and outcomes. Results: A total of 107 acute scrotum presentations were identified: 58 (54.2%) testicular appendage torsion, 23 (21.5%) testicular torsion, 6 (5.6%) epididymo-orchidits and 20 (18.7%) other diagnoses. Median age at presentation was 11 years (4 months–16 years). Fifty-seven (53.3%) underwent emergency surgery, of whom 23 (40.4%) had testicular torsion, with 2 requiring orchidectomy. Median time from onset of symptoms to seeking medical opinion was 5.5 (0–135) h. Once assessed by a medical professional, the route to paediatric surgical review via general practitioner (GP) and local emergency department (ED) to paediatric ED was 4.84 (1.67–24.5) h; via GP to paediatric ED was 2.58 (0.75–25.5) h; via local ED to paediatric ED was 2.25 (1–7.75) h; and directly to paediatric ED was 0.45 (0–1.42) h. Conclusion: Delays in assessment and treatment of acute scrotal pain occur from the time parents are aware of symptoms to seeking medical opinion. Education to increase awareness may reduce time delays. GPs should refer patients directly to a paediatric ED. Local EDs should manage paediatric cases as per the local surgeons' skill base.

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KW - epididymo-orchitis

KW - paediatric

KW - testicular appendage

KW - testicular torsion

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