A 5-year Retrospective Study of Pediatric Acute Scrotum; Evaluating Testicular Torsion Versus Torsion of the Testicular Appendage and Epididymo-Orchitis
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Date
2020
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Rīgas Stradiņa universitāte
Rīga Stradiņš University
Rīga Stradiņš University
Abstract
Ievads: Akūts sēklinieka sindroms ir viena no biežākajām akūtajām ķirurģiskajām saslimšanām bērniem. Ir kritiski nozīmīgi agrīni diegnosticēt testis torsiju un diferencēt to no citām saslimšanām, kuras rada sēklinieku maisiņa sāpes, lai nodrošinātu agrīnu un adektāvu ārstēšanu, tā palielinot iespēju saglabāt testis dzīvotspēju.
Mērķi: Pētījuma mērķis bija novērtēt bērnu ārstēšanas un diagnostikas norisi un tās ietekmi uz iznākumu no simptomu sākuma brīža līdz ārstēšanas uzsākšanai Bērnu klīniskās universitātes slimnīcā ārstētajiem bērniem.
Materiāli un metodes: Tika veikta retrospektīva datu analīze Neatliekamās palīdzības nodaļas pacientiem vecumā no 1 līdz 18 gadiem laika posmā no 2014. gada janvāra līdz 2019. gadam. Tika izsekota notikumu norise laikā no pirmajiem simptomiem līdz iestāšanās brīdim Nealiekamās palīdzības nodaļā, attēldiagnostikai, diagnozes uzstādīšanai un ķirurģiskai ārstēšanai. No pacientu vēsturēs esošās informācijas tika aprēķināta Acute Scrotum Score (ASS), lai izvērtētu torsijas risku.
Rezultāti: No 513 pētījumā iekļautajiem pacientiem 107 bija diagnosticēta testis torsija, 302 tika konsatēta sīklinieka piedēkļa torsija un 104 epididimoorhīts. No šiem pacientiem 463 (90.3%) tika veikta ķirurģiska ārstēšana, un pārējie 50 (9.7%) tika ārstēti konservatīvi. Testis dzīvotspēja tika saglabāta 81 (75.7%) gadījumā un orhidektomija tika veikta 26 (24.3%) pacientiem, kuri vēlīni vērsās pēcpalīdzības Neatliekamās palīdzības nodaļā. ROC testā ASS atlases vērtība zema riska grupā esošajiem pacientiem bija 5, savukārt augsta riska grupas pacientiem 6 ar pozitīvo paredzes vērtību 93.1% un patiesi negatīvo vērtību 65.9% (p<0.001).
Secinājumi: Novēlota iestāšanās Neatliekamās palīdzības nodaļā ir viens no rādītājiem, kuru potenciāli varētu mainīt. Veicot jaunu vīriešu un bērnu vecāku izglītošanu ar veselību saistītos jautājumos, varētu efektīvi samazināt laiku no simptomu sākumā līdz iestāšanās brīdim stacionārā, kā rezultātā būtu iespējams uzlabot testis saglabāšanas rādītājus. Turklāt, Acute Scrotum Score varētu tikt izmantots kā līdzeklis agrīnai testis torsijas diagnostikai, jo šajā pētījuma populācijā tas uzrādīja augstu paredzes vērtību.
Background: Acute scrotal pain is one of the most common pediatric complaints presenting to the Emergency Department. Differentiating and diagnosing testicular torsion from other causes of testicular pain on time is critically important in order to improve salvage rates of affected testes and therefore requires adequate management. Aim: The objective of our study was to evaluate the timeline of a patient with acute scrotum and its impact on the outcome of treatment from onset of symptoms until the treatment of young children who presented to the Children’s Clinical University Hospital in Riga, Latvia. Materials and Methods: A retrospective review of children presenting to the Emergency Department between the ages of 1 to 18 years with acute scrotal pain from January 2014 till 2019 was done. A timeline was established from first onset of symtpoms to admission to the Emergency Department, imaging, diagnosis and surgical findings, in that order respectively. Through medical records, an Acute Scrotum Score (ASS) was established to predict risk of torsion. Results: Out of 513 patients included in the study, 107 had a testicular torsion, 302 a torsion of the testicular appendage and 104 epididymo-orchitis. From these cases, 463 (90.3%) children underwent exploratory surgery, and the remaining 50 (9.7%) were managed conservatively. Testicular salvation was achieved in 81 (75.7%) patients and orchiectomy was performed in 26 (24.3%) due to a delayed presentation to the Emergency Department. ROC curve analysis had ASS cutoff values of 5 and 6 points for low and high-risk groups respectively, with a positive predictive value of 93.1% and true negative value of 65.9% (p<0.001). Conclusions: Delayed presentation to the Emergency Department is a modifiable outcome. By implementation of health care education targeting both parents and young males, it could serve as an effective method in order to promote early presentation and thus increasing testicular salvage. Furthermore, the Acute Scrotum Score could potentially be used as an early diagnostic tool, as it was a highly predictive method in our study population, especially in clinics where trained pediatric surgeons are not available.
Background: Acute scrotal pain is one of the most common pediatric complaints presenting to the Emergency Department. Differentiating and diagnosing testicular torsion from other causes of testicular pain on time is critically important in order to improve salvage rates of affected testes and therefore requires adequate management. Aim: The objective of our study was to evaluate the timeline of a patient with acute scrotum and its impact on the outcome of treatment from onset of symptoms until the treatment of young children who presented to the Children’s Clinical University Hospital in Riga, Latvia. Materials and Methods: A retrospective review of children presenting to the Emergency Department between the ages of 1 to 18 years with acute scrotal pain from January 2014 till 2019 was done. A timeline was established from first onset of symtpoms to admission to the Emergency Department, imaging, diagnosis and surgical findings, in that order respectively. Through medical records, an Acute Scrotum Score (ASS) was established to predict risk of torsion. Results: Out of 513 patients included in the study, 107 had a testicular torsion, 302 a torsion of the testicular appendage and 104 epididymo-orchitis. From these cases, 463 (90.3%) children underwent exploratory surgery, and the remaining 50 (9.7%) were managed conservatively. Testicular salvation was achieved in 81 (75.7%) patients and orchiectomy was performed in 26 (24.3%) due to a delayed presentation to the Emergency Department. ROC curve analysis had ASS cutoff values of 5 and 6 points for low and high-risk groups respectively, with a positive predictive value of 93.1% and true negative value of 65.9% (p<0.001). Conclusions: Delayed presentation to the Emergency Department is a modifiable outcome. By implementation of health care education targeting both parents and young males, it could serve as an effective method in order to promote early presentation and thus increasing testicular salvage. Furthermore, the Acute Scrotum Score could potentially be used as an early diagnostic tool, as it was a highly predictive method in our study population, especially in clinics where trained pediatric surgeons are not available.
Description
Medicīna
Medicine
Veselības aprūpe
Health Care
Medicine
Veselības aprūpe
Health Care
Keywords
Akūts scrotum Scrotum sāpes Testis torsija Testis piedēkļa torsija Morgagni Epididimoorhīts Orhidektomija, Acute Scrotum Scrotal pain Testicular torsion Torsion of appendix testis Morgagni Epididymo-orchitis Orchiectomy