University of California, Irvine, Department of Urology, Irvine, CA, USA; CHOC Children's, Division of Pediatric Urology, Orange, CA, USA.
Seattle Children's, Division of Pediatric Urology, Seattle, WA, USA.
J Pediatr Urol. 2021 Aug;17(4):478.e1-478.e6. doi: 10.1016/j.jpurol.2021.03.013. Epub 2021 Mar 19.
Testicular torsion is a surgical emergency, and time to detorsion is imperative for testicular salvage. During the COVID-19 pandemic, patients may delay emergency care due to stay-at-home orders and concern of COVID-19 exposure.
To assess whether emergency presentation for testicular torsion was delayed during the COVID-19 pandemic, and whether the rate of orchiectomy increased compared to a retrospective period.
Patients were prospectively enrolled in a multicenter study from seven institutions in the United States and Canada. Inclusion criteria were patients two months to 18 years of age with acute testicular torsion from March through July 2020. The retrospective group included patients from January 2019 through February 2020. Statistical analysis was performed using Kruskal-Wallis tests, Chi-square tests, and logistic regression.
A total of 221 patients were included: 84 patients in the COVID-19 cohort and 137 in the retrospective cohort. Median times from symptom onset to emergency department presentation during COVID-19 compared to the retrospective period were 17.9 h (IQR 5.5-48.0) and 7.5 h (IQR 4.0-28.0) respectively (p = 0.04). In the COVID-19 cohort, 42% of patients underwent orchiectomy compared to 29% of pre-pandemic controls (p = 0.06). During COVID-19, 46% of patients endorsed delay in presentation compared to 33% in the retrospective group (p = 0.04).
We found a significantly longer time from testicular torsion symptom onset to presentation during the pandemic and a higher proportion of patients reported delaying care. Strengths of the study include the number of included patients and the multicenter prospective design during the pandemic. Limitations include a retrospective pre-pandemic comparison group.
In a large multicenter study we found a significantly longer time from testicular torsion symptom onset to presentation during the pandemic and a significantly higher proportion of patients reported delaying care. Based on the findings of this study, more patient education is needed on the management of testicular torsion during a pandemic.
睾丸扭转是一种外科急症，为了挽救睾丸，必须尽快进行松解扭转。在 COVID-19 大流行期间，由于居家令和对 COVID-19 感染的担忧，患者可能会延迟紧急护理。
评估在 COVID-19 大流行期间是否延迟了睾丸扭转的紧急就诊，以及与回顾性时期相比，睾丸切除术的发生率是否增加。
患者前瞻性纳入美国和加拿大的 7 个机构的多中心研究。纳入标准为年龄在 2 个月至 18 岁之间、有急性睾丸扭转的患者，纳入时间为 2020 年 3 月至 7 月。回顾性组包括 2019 年 1 月至 2020 年 2 月的患者。使用 Kruskal-Wallis 检验、卡方检验和逻辑回归进行统计分析。
共纳入 221 例患者：COVID-19 组 84 例，回顾性组 137 例。COVID-19 组与回顾性组从症状发作到急诊就诊的中位时间分别为 17.9 小时（IQR 5.5-48.0）和 7.5 小时（IQR 4.0-28.0）（p=0.04）。COVID-19 组中 42%的患者行睾丸切除术，而前疫情对照组为 29%（p=0.06）。在 COVID-19 期间，46%的患者表示就诊延迟，而回顾性组为 33%（p=0.04）。
我们发现，在大流行期间，从睾丸扭转症状发作到就诊的时间明显延长，并且有更多的患者报告延迟治疗。本研究的优势包括纳入的患者数量和大流行期间的多中心前瞻性设计。局限性包括回顾性的疫情前对照组。
在一项大型多中心研究中，我们发现，在大流行期间，从睾丸扭转症状发作到就诊的时间明显延长，并且有更多的患者报告延迟治疗。基于这项研究的结果，需要在大流行期间对睾丸扭转的管理进行更多的患者教育。
