An assessment of social determinants of health and time to presentation for testicular torsion.

Abstract

Introduction: Testicular torsion is a time-sensitive urologic emergency that requires prompt intervention to preserve testicular function. Previous studies have investigated orchiectomy rates in association with social determinants of health (SDoHs) and found that those without private insurance and Black individuals have higher rates of orchiectomy following testicular torsion. However, there is limited data regarding the impact of SDoHs and time to presentation to a healthcare facility for pediatric patients with testicular torsion.

Methods: We conducted a retrospective chart review of pediatric patients with testicular torsion between 2013 and 2022. Patients were excluded from the study if they were 18 and older, less than one month old, did not have documented time of symptom onset, or did not receive urgent surgical treatment at our facility. Time to presentation and surgical outcome was analyzed in association with race, ethnicity, use of interpreter and insurance status.

Results: A total of 253 pediatric patients with a median age of 13.9 years were included in the study. There was no significant relationship between ethnicity, race and use of an interpreter and time to presentation. However, patients with public insurance had a longer time to presentation (11.5 h, IQR 3.9-49.3) when compared to those with private insurance and (4.9 h, IQR 2.75-26.2, p = 0.004). There was no relationship between race, Hispanic and non-Hispanic ethnicity, use of an interpreter and insurance status with orchiectomy rates.

Conclusions: This study found that within the pediatric population, public insurance status predicted longer time to presentation for patients presenting with testicular torsion. This highlights the importance of access to healthcare facilities for those presenting with testicular torsion. Further work is needed to identify modifiable barriers to presentations in care for testicular torsion.