ABSTRACT
Background:
Acute scrotal
pain (
ASP) is the most common urological
emergency in
pediatrics, and its causes include
testicular torsion (TT), testicular appendage torsion, and epididymo-
orchitis. Among them, TT requires prompt and accurate
diagnosis and urgent surgical exploration to prevent testicular loss. Conservative anti-infective
treatment is recommended for epididymo-
orchitis, and
surgery is considered only when scrotal
abscess formation and
sepsis occur. Improving the
understanding of TT in
primary care doctors,
early diagnosis, and timely surgical exploration are essential to improve the
survival rate of TT and avoid excessive
treatment. This study aimed to explore the
risk factors for TT in
children with
ASP and construct a predictive model.
Methods:
Clinical data of
children who presented with
ASP and underwent
emergency scrotal exploration
surgery were retrospectively analyzed, including general information,
physical examination,
laboratory tests, and
color Doppler ultrasonography (CDU) findings. Based on surgical exploration, the outcomes were categorized as confirmed TT or not.
Results:
A total of 283
children were included in this study, among whom 134 had TT. The mean age of all
patients was 105±47.9 months, with the majority being of Han
ethnicity (87.6%) and residing in
urban areas (83%). Most
patients had normal
C-reactive protein levels and
negative results in
urine routine
white blood cell tests (63.3%). After conducting univariate and multivariate
logistic regression analyses, we identified laterality,
neutrophil count, mean
erythrocyte sedimentation rate, epididymal
blood flow signal, testicular parenchymal echogenicity, and testicular
blood flow signal as independent
risk factors influencing the occurrence of TT in
ASP patients.
Conclusions:
This study is the
report with the largest
sample size on the
construction of prediction models for
ASP in
children in southwestern
China. The predictive model we developed demonstrated excellent performance and higher accuracy in predicting TT in
children compared to the traditional Testicular Workup for
Ischemia and Suspected Torsion (TWIST) score. It can assist pediatric
surgeons in diagnosing and treating
children with
ASP.