Point of care ultrasound (POCUS) in acute pediatric scrotum: enhancing clinical decision-making.

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.