Implementing Point‐of‐Care Ultrasound for Acute Scrotal Pain in the Pediatric Emergency Department

Abstract

ObjectivesTesticular torsion (TT) is a pediatric surgical emergency that requires prompt treatment. This study investigated the feasibility of point‐of‐care ultrasound (POCUS) for diagnosing TT in the pediatric emergency department (ED).MethodsWe retrospectively reviewed the medical records of patients, aged 18 years or younger, who visited a university‐affiliated hospital pediatric ED with acute scrotal pain without trauma history and underwent diagnostic ultrasounds between January 2010 and October 2022.ResultsThis study included 731 patients (median age: 9 years), Of these, 315 (43%) were in the POCUS‐performed group: 188 in the POCUS‐only group, and 127 in the POCUS‐and‐RADUS group. The other 416 patients (56.9%) were in the RADUS‐only group. In total, 45 patients (6.2%) were diagnosed with TT (19 in the POCUS‐performed group and 26 in the RADUS‐only group). The sensitivity, specificity, and positive and negative predictive values of POCUS for diagnosing TT were 94.7%, 92.9%, 46.2%, and 99.6%, respectively. The median time to perform POCUS was shorter than RADUS (23 versus 61 minutes, P < .001). The POCUS‐performed group had a shorter ED length of stay than the RADUS‐only group (93 versus 170 minutes, P < .001). Among the patients diagnosed with TT, performing POCUS first did not significantly delay the ED process, including time to operation (250 versus 205 minutes, P = .142).ConclusionsFor patients with acute scrotal pain, evaluation performed by pediatric emergency physicians using POCUS performs well in screening TT, and can decrease length of stay in the ED.