Development and Initial Validation of a Scoring System to Diagnose Testicular Torsion in Children

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dc.contributor Sistema FMUSP-HC: Faculdade de Medicina da Universidade de São Paulo (FMUSP) e Hospital das Clínicas da FMUSP BARBOSA, Joao A. FMUSP-HC
TISEO, Bruno Camargo FMUSP-HC
BARAYAN, Ghassan A.
ROSMAN, Brian M.
TORRICELLI, Fabio Cesar Miranda FMUSP-HC
RETIK, Alan B.
NGUYEN, Hiep T. 2013
dc.identifier.citation JOURNAL OF UROLOGY, v.189, n.5, p.1859-1864, 2013
dc.identifier.issn 0022-5347
dc.description.abstract Purpose: Testicular torsion is a surgical emergency requiring prompt intervention. Although clinical diagnosis is recommended, scrotal ultrasound is frequently ordered, delaying treatment. We created a scoring system to diagnose testicular torsion, decreasing the indication for ultrasound. Materials and Methods: We prospectively evaluated 338 patients with acute scrotum, of whom 51 had testicular torsion. Physical examination was performed by a urologist, and all patients underwent scrotal ultrasound. Univariate analysis and logistic regression were performed, and a scoring system for risk stratification of torsion was created. Retrospective validation was performed with 2 independent data sets. Results: The scoring system consisted of testicular swelling (2 points), hard testicle (2), absent cremasteric reflex (1), nausea/vomiting (1) and high riding testis (1). Cutoffs for low and high risk were 2 and 5 points, respectively. Ultrasound would be indicated only for the intermediate risk group. In the prospective data set 69% of patients had low, 19% intermediate and 11.5% high risk. Negative and positive predictive values were 100% for cutoffs of 2 and 5, respectively (specificity 81%, sensitivity 76%). Retrospective validation in 1 data set showed 66% of patients at low, 16% intermediate and 17% high risk. Negative and positive predictive values for cutoffs of 2 and 5 were 100% (specificity 97%, sensitivity 54%). The second retrospective data set included only torsion cases, none of which was misdiagnosed by the scoring system. Conclusions: This scoring system can potentially diagnose or rule out testicular torsion in 80% of cases, with high positive and negative predictive values for selected cutoffs. Ultrasound orders would be decreased to 20% of acute scrotum cases. Prospective validation of this scoring system is necessary.
dc.language.iso eng
dc.relation.ispartof Journal of Urology
dc.rights restrictedAccess
dc.subject diagnosis; research design; scrotum; spermatic cord torsion; ultrasonography
dc.subject.other acute scrotal pain; doppler ultrasound; pediatric-patients; sonography
dc.title Development and Initial Validation of a Scoring System to Diagnose Testicular Torsion in Children
dc.type article
dc.rights.holder Copyright ELSEVIER SCIENCE INC LIM/55
dc.identifier.doi 10.1016/j.juro.2012.10.056
dc.identifier.pmid 23103800
dc.type.category original article
dc.type.version publishedVersion BARBOSA, Joao A.:FM: TISEO, Bruno Camargo:HC:ICHC TORRICELLI, Fabio Cesar Miranda:FM: PASSEROTTI, Carlo C.:HC:ICHC SROUGI, Miguel:FM:MCG · BARAYAN, Ghassan A.:Boston Childrens Hosp, Dept Urol, Boston, MA 02115 USA
· ROSMAN, Brian M.:Boston Childrens Hosp, Dept Urol, Boston, MA 02115 USA
· RETIK, Alan B.:Boston Childrens Hosp, Dept Urol, Boston, MA 02115 USA
· NGUYEN, Hiep T.:Boston Childrens Hosp, Dept Urol, Boston, MA 02115 USA WOS:000319262900083 2-s2.0-84876283768 NEW YORK USA
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dc.description.index MEDLINE
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hcfmusp.citation.wos 21 Brasil Estados Unidos

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