Although this articles comes from a tertiary centre in Columbus, USA, there are similarities with the current controversies in the UK. The authors carried out a five-year retrospective review looking at the surgical transfer of 125 patients (mean age 13.4, range 4 months – 21.7 years; only 4 > 18 years) with testicular torsion (perinatal and intermittent torsion was excluded). Transferred patients (group T) were those who were referred to the tertiary emergency department after evaluation elsewhere where no suitable person was present to operate. Non transferred patients (group NT) were those where the initial presentation was at the tertiary centre or where there were appropriate persons available to operate – in this case attending urologists from the centre. A number of typical parameters such as testicular viability, distance of transfer, and duration of symptoms were collected. Thirty-six patients were in group T and 89 in NT. There was no difference between the two groups in age. Group T had a duration of symptoms of 28 hours vs. 18.7 hours in the NT group. Testicular loss occurred 45 times requiring orchidectomy and a further two with severe atrophy on follow-up gives a testicular loss rate overall of 37.6%. Comparing patients with symptoms < 24 hours at the time of presentation showed no difference of duration of symptoms at the time of presentation to the tertiary centre between T and NT (6.7 hours and 4.9 hours, respectively) but 30.4% of T vs. 15.2% of NT experienced testicular loss. Ultrasound examination prior to transfer contributed to delay in transfer resulting in increased odds of testicular loss (OR 3.73, 95% CI 1.09-12.81). Patients transferred > 30 miles had an increased testicular loss versus those that transferred less than 30 miles (42.9% vs. 15.2%). Of note also was that patients were more likely to be transferred during ‘unsocial’ hours and it was hypothesised that this was due to anaesthetic cover factors and other staffing cover. Multivariate analysis of risk factors for testicular loss in those that had symptoms < 24 hours, showed that only symptom duration demonstrated significant difference (p=0.0002). The authors conclude that urologists on site should correct torsion when able.

Indicators and outcomes of transfer to tertiary pediatric hospitals for patient with testicular torsion.
Preece J, Ching C, Yackey K, et al.
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Henrik Steinbrecher

Southampton University Hospital NHS Trust

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