Hurdles to boys with acute scrotal pain being evaluated and treated in district general hospitals: we are not Getting It Right the First Time yet.

Abstract

Introduction: Testicular torsion is a time-critical emergency, though its incidence in the paediatric age group is relatively rare. Changes in training pathways have led to a decreasing number of adult general surgical and urological trainees being comfortable in performing an emergency scrotal exploration in children, resulting in children being transferred to regional units with the requisite expertise. This delay has been shown to increase the risk of orchidectomy. There is, therefore, an increased emphasis on the diagnostic evaluation of these children by emergency department staff.

Methods: We explore how lack of experience and availability of appropriate investigations led to transfer of children presenting to a district general hospital in the North East of England.

Results: Children with true testicular torsion in this cohort had an unacceptably high rate of needing an orchidectomy (∼67%) compared with the reported incidence of orchidectomy with testicular torsion (∼20%).

Conclusions: We offer potential solutions to the hurdles that have to be overcome to improve this service. This will align the service to the recently published Get It Right First Time report on the management of testicular torsion in children and young adults and is within the remit of Operational Delivery Networks.