Julia B Finkelstein, Bryce Weber, Susan Quigley, Shuvro De, Anja Zann, Kyle Rove, Debra Liebrecht, Rebecca Zee, Yvonne Chan, Shane Battie, Hans Pohl, Ching Man Carmen Tong, Anne Dudley, Leslie McQuiston, Emily T Durkin, Tanya D Davis, Jill Whitehouse, Ethan Polsky, Mary Killian, His-Yang Wu, Ed Gong, David Chalmers, T Ernesto Figueroa, Gwen Grimsby, Nicolas Fernandez, Natalia Ballesteros, Jacqueline M Saito, Peter Metcalfe, Megan Schober, Sarah Lambert, Catherine Grant, Jonathan S Ellison
{"title":"Leveraging NSQIPP testicular torsion process measures: Initial survey of the NSQIPP testicular torsion collaborative.","authors":"Julia B Finkelstein, Bryce Weber, Susan Quigley, Shuvro De, Anja Zann, Kyle Rove, Debra Liebrecht, Rebecca Zee, Yvonne Chan, Shane Battie, Hans Pohl, Ching Man Carmen Tong, Anne Dudley, Leslie McQuiston, Emily T Durkin, Tanya D Davis, Jill Whitehouse, Ethan Polsky, Mary Killian, His-Yang Wu, Ed Gong, David Chalmers, T Ernesto Figueroa, Gwen Grimsby, Nicolas Fernandez, Natalia Ballesteros, Jacqueline M Saito, Peter Metcalfe, Megan Schober, Sarah Lambert, Catherine Grant, Jonathan S Ellison","doi":"10.1016/j.jpurol.2025.06.030","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Testicular torsion is a pediatric emergency that poses a time-sensitive risk to the testicle. Best practices for testicular torsion protocols remain unclear. We convened the Testicular Torsion Collaborative, leveraging National Surgical Quality Improvement Program Pediatric (NSQIPP) Testicular Torsion Process Measure collection to assess factors associated with favorable metrics.</p><p><strong>Methods: </strong>Data were accrued across 29 participating NSQIPP sites, excluding neonatal and non-urgent cases. Post-processed data available through NSQIPP included site of initial presentation and time stamps for presentation, ultrasound, and operating room entry; number of cases greater than the NSQIPP median for each time stamp; and orchiectomy rate. Hospital level data and torsion-related care processes were collected from each participating site via an electronic survey.</p><p><strong>Results: </strong>From 10/1/2021 to 9/30/22, 1007 testicular torsion patients were included, with 494 (49.1 %) transferred from another institutions. A standardized evaluation protocol was associated with fewer patients exceeding the NSQIPP median from presentation to ultrasound (38.8 % vs 60 %, p = 0.03). Testicular Workup for Ischemia and Suspected Torsion (TWIST) score use was associated with a shorter time frame from presentation to ultrasound (0.7 vs 1.1 h, p = 0.03). Free-standing children's hospitals (p > 0.01) and institutions with an American College of Surgeons Children's Surgery Verification (p = 0.03) also demonstrated improved time to ultrasound. Overall orchiectomy rate was 15.8 % and there were no statistical differences noted across the study variables.</p><p><strong>Conclusions: </strong>Across a wide spectrum of hospitals within NSQIPP, we demonstrate that certain torsion-related processes and hospital-level factors are associated with faster times to ultrasound. The NSQIPP Testicular Torsion Collaborative will continue to explore interventions to improve testicular torsion care and outcomes.</p>","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":" ","pages":""},"PeriodicalIF":2.0000,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Pediatric Urology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.jpurol.2025.06.030","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"PEDIATRICS","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Testicular torsion is a pediatric emergency that poses a time-sensitive risk to the testicle. Best practices for testicular torsion protocols remain unclear. We convened the Testicular Torsion Collaborative, leveraging National Surgical Quality Improvement Program Pediatric (NSQIPP) Testicular Torsion Process Measure collection to assess factors associated with favorable metrics.
Methods: Data were accrued across 29 participating NSQIPP sites, excluding neonatal and non-urgent cases. Post-processed data available through NSQIPP included site of initial presentation and time stamps for presentation, ultrasound, and operating room entry; number of cases greater than the NSQIPP median for each time stamp; and orchiectomy rate. Hospital level data and torsion-related care processes were collected from each participating site via an electronic survey.
Results: From 10/1/2021 to 9/30/22, 1007 testicular torsion patients were included, with 494 (49.1 %) transferred from another institutions. A standardized evaluation protocol was associated with fewer patients exceeding the NSQIPP median from presentation to ultrasound (38.8 % vs 60 %, p = 0.03). Testicular Workup for Ischemia and Suspected Torsion (TWIST) score use was associated with a shorter time frame from presentation to ultrasound (0.7 vs 1.1 h, p = 0.03). Free-standing children's hospitals (p > 0.01) and institutions with an American College of Surgeons Children's Surgery Verification (p = 0.03) also demonstrated improved time to ultrasound. Overall orchiectomy rate was 15.8 % and there were no statistical differences noted across the study variables.
Conclusions: Across a wide spectrum of hospitals within NSQIPP, we demonstrate that certain torsion-related processes and hospital-level factors are associated with faster times to ultrasound. The NSQIPP Testicular Torsion Collaborative will continue to explore interventions to improve testicular torsion care and outcomes.
背景：睾丸扭转是一种儿科急症，对睾丸有时间敏感性风险。睾丸扭转方案的最佳实践尚不清楚。我们召集了睾丸扭转协作，利用国家儿科手术质量改进计划（NSQIPP）睾丸扭转过程测量收集来评估与有利指标相关的因素。方法：在29个参与NSQIPP的站点收集数据，不包括新生儿和非紧急病例。NSQIPP提供的后处理数据包括初次就诊地点、就诊时间、超声检查和进入手术室；每个时间戳的病例数大于NSQIPP中位数；睾丸切除率。通过电子调查从每个参与站点收集医院级数据和与扭转相关的护理过程。结果：2021年1月10日至22年9月30日共纳入1007例睾丸扭转患者，其中转院494例（49.1%）。标准化评估方案与超过NSQIPP中位值的患者较少相关（38.8% vs 60%, p = 0.03）。睾丸缺血和疑似扭转检查（TWIST）评分的使用与从出现到超声检查的时间较短相关（0.7 vs 1.1 h, p = 0.03）。独立儿童医院（p < 0.01）和获得美国外科医师学会儿童外科认证的机构（p < 0.03）的超声检查时间也有所改善。总体睾丸切除术率为15.8%，研究变量间无统计学差异。结论：在NSQIPP范围内的广泛医院中，我们证明了某些与扭转相关的过程和医院层面的因素与更快的超声时间有关。NSQIPP睾丸扭转协作将继续探索干预措施，以改善睾丸扭转的护理和结果。
期刊介绍：
The Journal of Pediatric Urology publishes submitted research and clinical articles relating to Pediatric Urology which have been accepted after adequate peer review.
It publishes regular articles that have been submitted after invitation, that cover the curriculum of Pediatric Urology, and enable trainee surgeons to attain theoretical competence of the sub-specialty.
It publishes regular reviews of pediatric urological articles appearing in other journals.
It publishes invited review articles by recognised experts on modern or controversial aspects of the sub-specialty.
It enables any affiliated society to advertise society events or information in the journal without charge and will publish abstracts of papers to be read at society meetings.
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