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Войти в исследования The Journal of emergency medicine · 2026
Time-Critical Diagnosis of Pediatric Testicular Torsion in a Tertiary Pediatric Emergency Setting: Integrating Clinical Predictors With Selective Doppler Ultrasound.
СтатьяНаблюдательное исследованиеНазвание и аннотация: Перевод в очереди
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Zouari Mohamed, Belhajmansour Manel, Hbaieb Manar, Laadhar Mahmoud, Issaoui Asma, Dhaou Mahdi Ben, Mhiri Riadh
Аннотация
BACKGROUND: Acute scrotum is a frequent pediatric emergency encompassing a heterogeneous spectrum of conditions, among which testicular torsion (TT) represents the most time-critical diagnosis.
OBJECTIVES: The aim of this study was to evaluate the diagnostic performance of clinical predictors and ultrasound in children presenting with acute scrotum, and to identify factors associated with TT.
METHODS: We conducted a prospective observational cohort study including consecutive children presenting with non-traumatic acute scrotum between January 2022 and December 2025 at a tertiary pediatric surgical center.
RESULTS: During the 4-year study period, 189 children were prospectively enrolled. The median age was 11 years. Testicular torsion was confirmed in 41 patients. Scrotal Doppler ultrasound was performed in 72 patients (38.1%) with an overall accuracy of 94%. The accuracy of the Testicular Workup for Ischemia and Suspected Torsion (TWIST) score was 82%. On multivariable analysis, three independent predictors of TT were identified: pain duration < 24 h (OR = 19.251, 95% CI 5.355-69.210, p < 0.001), TWIST score ≥ 3 (OR = 35.987, 95% CI 2.49-370.7, p < 0.001), and scrotal erythema (OR = 6.277, 95% CI 1.572-25.061, p = 0.009).
CONCLUSIONS: In pediatric acute scrotum, scrotal Doppler ultrasound demonstrates excellent diagnostic accuracy when performed, while structured clinical assessment remains crucial for early risk stratification and time-critical decision-making. These findings support an integrated, probability-based diagnostic approach in which clinical predictors guide the selective and timely use of ultrasound, without delaying surgical exploration.
OBJECTIVES: The aim of this study was to evaluate the diagnostic performance of clinical predictors and ultrasound in children presenting with acute scrotum, and to identify factors associated with TT.
METHODS: We conducted a prospective observational cohort study including consecutive children presenting with non-traumatic acute scrotum between January 2022 and December 2025 at a tertiary pediatric surgical center.
RESULTS: During the 4-year study period, 189 children were prospectively enrolled. The median age was 11 years. Testicular torsion was confirmed in 41 patients. Scrotal Doppler ultrasound was performed in 72 patients (38.1%) with an overall accuracy of 94%. The accuracy of the Testicular Workup for Ischemia and Suspected Torsion (TWIST) score was 82%. On multivariable analysis, three independent predictors of TT were identified: pain duration < 24 h (OR = 19.251, 95% CI 5.355-69.210, p < 0.001), TWIST score ≥ 3 (OR = 35.987, 95% CI 2.49-370.7, p < 0.001), and scrotal erythema (OR = 6.277, 95% CI 1.572-25.061, p = 0.009).
CONCLUSIONS: In pediatric acute scrotum, scrotal Doppler ultrasound demonstrates excellent diagnostic accuracy when performed, while structured clinical assessment remains crucial for early risk stratification and time-critical decision-making. These findings support an integrated, probability-based diagnostic approach in which clinical predictors guide the selective and timely use of ultrasound, without delaying surgical exploration.