Objective
To describe the incidence of missed diagnosis and delayed presentation in children
with testicular torsion, and to identify associated risk factors.
Materials and Methods
The medical records of all children over 1 month of age diagnosed with testicular
torsion between 2008 and 2014 were reviewed. Data pertaining to patient characteristics
and treatment outcome were collected. Orchiectomy was categorized as caused by either
delayed presentation or missed diagnosis. Logistic regression analyses were used to
evaluate the association between patient characteristics and treatment outcome.
Results
The study cohort included 100 children, 40 of whom underwent orchiectomy. Twenty-eight
patients arrived with delayed presentation, and 12 were incorrectly diagnosed. On
univariable logistic regression analyses, young age, long duration of pain, and prior
community clinic examination were significantly associated with orchiectomy. Similarly,
these variables were associated with delayed presentation and missed diagnosis when
compared with the orchiopexy group. On multivariable analysis, young age and long
duration of pain remained significant predictors of orchiectomy. Doppler ultrasound
was performed in 70 patients; 7 of 70 ultrasounds were incorrectly diagnosed. Young
age was associated with missed sonographic diagnosis, whereas ultrasound performer
(senior radiologist vs resident) and time of the day were not.
Conclusion
Missed diagnosis may account for up to 12% of orchiectomy cases. Younger age and prior
community clinic examination increase the risk of incorrect diagnosis. Doppler ultrasound
should be used with discretion and its results interpreted cautiously.
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Article info
Publication history
Published online: December 30, 2016
Accepted:
December 20,
2016
Received:
September 2,
2016
Footnotes
Financial Disclosure: The authors declare that they have no relevant financial interests.
Identification
Copyright
© 2017 Elsevier Inc. All rights reserved.
