Abdominal radiology (New York) · 2025
Point of care ultrasound (POCUS) in acute pediatric scrotum: enhancing clinical decision-making.
СтатьяНазвание и аннотация: Перевод в очереди
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Elsheikh Amgad M, Almalki Yassir Edrees, Elsayed Mohamed Heba Abdelmonem, Basha Mohammad Abd Alkhalik, Altaher Khaled Mohamed, Mohamed Ahmed Shaimaa Hosny, Sobhi Hassan Tarek Mohamed, Dawoud Bassant Mahmoud, Teama Amr M, Alaa Eldin Ahmed M
Аннотация
RATIONALE AND OBJECTIVES: To evaluate the diagnostic accuracy and reliability of point-of-care ultrasound (POCUS) in pediatric acute scrotal emergencies and assess its impact on clinical decision-making for differentiating surgical from non-surgical conditions.
MATERIALS AND METHODS: This prospective study conducted at a tertiary care center between March 2023 and October 2024, included 294 pediatric patients (age 1-17.9 years) presenting to the pediatric emergency department with acute scrotal pain. POCUS examinations were performed using B-mode and color Doppler imaging. Diagnoses were confirmed through surgical intervention (n = 102), clinical follow-up (n = 58), or imaging follow-up (n = 134). Statistical analyses included diagnostic accuracy metrics, logistic regression for identifying predictors of surgical emergencies, and inter-examiner agreement using Cohen's kappa.
RESULTS: POCUS demonstrated 100% diagnostic accuracy in our sample for inflammatory conditions, testicular trauma, infarction, and scrotal abscess. For testicular torsion, sensitivity and specificity were 89.5% and 100%, while for appendiceal torsion, they were 94% and 97.5%, respectively. Multivariate analysis identified six significant predictors of surgical emergencies, with the strongest being scrotal tenderness (OR = 4.48, p < 0.001), reduced/absent Doppler vascularization (OR = 3.67, p < 0.001), and scrotal skin changes (OR = 3.32, p < 0.001). Inter-examiner agreement was almost perfect for hydrocele (κ = 0.91), testicular torsion (κ = 0.90), hematocele (κ = 0.86), and skin thickening (κ = 0.81).
CONCLUSION: POCUS offers high diagnostic accuracy for most pediatric scrotal conditions, though with relatively lower sensitivity for testicular torsion, requiring careful clinical correlation. When combined with clinical assessment, POCUS effectively differentiates surgical from non-surgical emergencies, potentially reducing unnecessary surgical interventions.
MATERIALS AND METHODS: This prospective study conducted at a tertiary care center between March 2023 and October 2024, included 294 pediatric patients (age 1-17.9 years) presenting to the pediatric emergency department with acute scrotal pain. POCUS examinations were performed using B-mode and color Doppler imaging. Diagnoses were confirmed through surgical intervention (n = 102), clinical follow-up (n = 58), or imaging follow-up (n = 134). Statistical analyses included diagnostic accuracy metrics, logistic regression for identifying predictors of surgical emergencies, and inter-examiner agreement using Cohen's kappa.
RESULTS: POCUS demonstrated 100% diagnostic accuracy in our sample for inflammatory conditions, testicular trauma, infarction, and scrotal abscess. For testicular torsion, sensitivity and specificity were 89.5% and 100%, while for appendiceal torsion, they were 94% and 97.5%, respectively. Multivariate analysis identified six significant predictors of surgical emergencies, with the strongest being scrotal tenderness (OR = 4.48, p < 0.001), reduced/absent Doppler vascularization (OR = 3.67, p < 0.001), and scrotal skin changes (OR = 3.32, p < 0.001). Inter-examiner agreement was almost perfect for hydrocele (κ = 0.91), testicular torsion (κ = 0.90), hematocele (κ = 0.86), and skin thickening (κ = 0.81).
CONCLUSION: POCUS offers high diagnostic accuracy for most pediatric scrotal conditions, though with relatively lower sensitivity for testicular torsion, requiring careful clinical correlation. When combined with clinical assessment, POCUS effectively differentiates surgical from non-surgical emergencies, potentially reducing unnecessary surgical interventions.