Predictivity of Clinical Findings and Doppler Ultrasound in Pediatric Acute Scrotum.

PURPOSE To evaluate the role of Doppler ultrasonography (DUS) in diagnosing pediatric testicular torsion (TT), and its diagnostic accuracy, and helping clinicians increase specificity and decrease negative exploration rates. MATERIALS AND METHODS We performed a retrospective study of all consecutive patients with acute testicular symptoms referring to our pediatric emergency department (ED) from January 2010 to December 2013. RESULTS We analyzed 1091 patients, with a mean age of 9 years. DUS was performed in 498 patients (40.8%); 107 patients (8.8%) underwent surgery and 41 patients (3.3%) had a TT. The following clinical findings were collected: presence of scrotal pain, erythema and swelling, spermatic cord pain and abnormal cremasteric reflex. The clinical findings significantly associated with TT were spermatic cord pain (OR = 37, 95% CI: 11.9-111.1, P < .001) and abnormal cremasteric reflex (OR = 47.6, 95% CI: 13.5-166.6, P < .001); the presence of swelling resulted confounding (OR = 2.3, 95% CI: 0.7-8.4, P < .001). Scrotal pain was not significantly associated with TT (P = .9), while erythema made TT unlikely (OR = 0.22, 95% CI: 0.07-0.7, P = .0445). In all cases the DUS significantly increased the predictivity. CONCLUSION TT was present in 3.3% of patients presenting with testicular symptoms. The predictivity based on clinical findings resulted high and the negative exploration rate for TT was 62%. DUS increased the predictivity in all patients.&nbsp.