A team of pediatric urologists, radiologists, emergency medicine specialists and anesthesiologists at Cincinnati Children’s is finding ways to reduce the time to treatment for patients with testicular torsion. The stakes are high: studies show a dramatic decrease in the testicular salvage rate when surgery does not occur within six hours of onset of the testicular pain.

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“Testicular torsion is one of the most common surgical emergencies in pediatric urology, and a misdiagnosis or delays in treatment can have devastating consequences for the patient,” says Brian VanderBrink, MD, pediatric urology. “Ultrasound is commonly ordered to diagnose torsion, and at Cincinnati Children’s those tests take place in a timely fashion. But we noticed some variability in terms of when ultrasound results were being communicated to the pediatric urologist on call.”

Previously, when a patient presented in the emergency department (ED) with symptoms of a possible torsion, the ED ordered the ultrasound and radiology communicated results back to the ED, which then paged the urologist as needed. In February 2016, radiology began communicating positive results directly to the urologist on call. Data collected from that point through May 2016 showed:

• The time from torsion diagnosis (in radiology) to surgical treatment decreased from 104 minutes to 69 minutes, a 34 percent reduction.
• The testicular salvage rate increased by about 13 percent.
• All testicular torsion patients were in surgery within four hours of presenting in the ED.

Only about 10 percent of patients who come to the Cincinnati Children’s ED with symptoms of testicular pain are ultimately diagnosed with testicular torsion, VanderBrink says. The team has created a standardized risk stratification system to identify which patients have a higher probability for the condition. The system, which is under prospective evaluation, assigns points based on the patient’s age and symptoms. Patients with high scores will be given immediate priority for an ultrasound scan, while those with a low score will be given standard priority. This will prevent unnecessary disruptions to the radiology department’s workflow, while ensuring that more likely cases receive immediate attention.