Sazgar Mohammad, Montazer Seyed Hossein, Hosseininejad Seyed Mohammad, Jahanian Fatemeh, Rezaimehr Behkam, Behbohaninia Mohammad, Aminiahidashti Hamed
Department of Emergency Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
Orthopedic Research Center, Mazandaran University of Medical Sciences, Sari, Iran.
Arch Acad Emerg Med. 2022 Jan 11;10(1):e9. doi: 10.22037/aaem.v10i1.1484. eCollection 2022.
Testicular torsion is an important and critical issue in patients with acute scrotum referring to emergency department (ED). Early detection is very important to save the testicles. This study aimed to determine the diagnostic accuracy of clinical variables in predicting the presence of testicular torsion.
This prospective cross-sectional study was done using the information of patients hospitalized from September 2015 to September 2020, with complaint of acute scrotum (ICD 10 code: N50.8), referring to ED for evaluation of the clinical predictors of testicular torsions, which were confirmed by surgery.
81 patients with the mean age of 20.07 ± 9.64 (3- 45) years were studied. After surgical exploration, 70 patients (86.4%) had testicular torsion. Patients with torsion had lower age (p < 0.0001), lower time from symptom to ED visit (p < 0.0001), sudden onset pain (p = 0.003), left side pain (p < 0.0001), and lower white blood cell (WBC) count (p = 0.001). The frequency of dysuria (p = 0.032), diarrhea/vomiting (p = 0.005), and fever (p = 0.002) was significantly lower in patients with torsion. The cremasteric reflex was absent in 57 (81.4%) cases who suffered from testicular torsion (p = 0.001). Based on the results of binary logistic regression analysis, age (B = -0.175, SE = 0.45; p < 0.0001) was the sole independent predictor of testicular torsion. The highest area under the receiver operating characteristics (ROC) curve in predicting the presence of torsion belonged to lower age [91.0 (95%CI: 83.2 - 98.7)], pain in left testis [0.931 (95%CI: 0.828-0.987)], and lower WBC count [0.805 (95%CI: 0.684-0.926)], respectively.
It seems that clinical variables are not accurate enough to be considered as the sole predictor of testicular torsion and they should be used with caution and in combination with other available screening tools like Doppler ultrasonography in this regard.
睾丸扭转是急诊科急性阴囊患者面临的一个重要且关键的问题。早期发现对于挽救睾丸至关重要。本研究旨在确定临床变量在预测睾丸扭转存在方面的诊断准确性。
本前瞻性横断面研究利用了2015年9月至2020年9月期间住院患者的信息，这些患者因急性阴囊症状（国际疾病分类第10版代码：N50.8）前往急诊科，以评估睾丸扭转的临床预测因素，这些因素通过手术得到证实。
研究了81例平均年龄为20.07±9.64（3 - 45）岁的患者。经手术探查，70例患者（86.4%）存在睾丸扭转。扭转患者年龄较小（p < 0.0001），从症状出现到就诊的时间较短（p < 0.0001），突发疼痛（p = 0.003），左侧疼痛（p < 0.0001），白细胞（WBC）计数较低（p = 0.001）。扭转患者排尿困难（p = 0.032）、腹泻/呕吐（p = 0.005）和发热（p = 0.002）的发生率显著较低。57例（81.4%）睾丸扭转患者提睾反射消失（p = 0.001）。基于二元逻辑回归分析结果，年龄（B = -0.175，SE = 0.45；p < 0.0001）是睾丸扭转的唯一独立预测因素。在预测扭转存在方面，受试者操作特征（ROC）曲线下面积最高的分别是年龄较小[91.0（95%可信区间：83.2 - 98.7）]、左侧睾丸疼痛[0.931（95%可信区间：0.828 - 0.987）]和白细胞计数较低[0.805（95%可信区间：0.684 - 0.926）]。
临床变量似乎不够准确，不能被视为睾丸扭转的唯一预测因素，在这方面应谨慎使用，并与其他可用的筛查工具如多普勒超声检查结合使用。
