4 EMERGENCY SCROTAL EXPLORATIONS IN A REGIONAL NETWORK: WHAT'S HOLDING US UP?
Jonathan Ducey, Govind Murthi
Sheffield Children's NHS Foundation Trust, Sheffield, United Kingdom

Abstract

Aim of the Study

Delays in progression to scrotal exploration can occur at multiple stages in the pre-operative pathway. Our aim was to identify causes of interventional delays to improve practice. Review of referral sources allowed secondary comparison of outcomes according to transfer status.

Methods

A clinical audit was performed against standards defined in the East Midlands Clinical Networks 2016 Commissioning Guide entitled ‘Management of Paediatric Torsion’ (EMCNMPT)1. Emergency scrotal explorations were highlighted retrospectively between April 2012 - May 2017. Case notes of the first retrospective 100 patients were reviewed. Neonatal torsions were excluded.

Main Results

  • Mean time to exploration from decision to operate (DTO) 142 minutes (range 29-964); 78% of cases explored within 3 hours DTO
  • Twenty-one patients were transferred from regional units; 19/21 were 'inappropriate' as per EMCNMPT, accounting for a mean delay to theatre of 147.8 minutes (range 53-306)
  • Thirty-eight patients had testicular torsion, with an orchidectomy rate of 11/38 (28.9%)
  • Transferred patients accounted for 6/11 (58.3%) of orchidectomies, with 5/6 retrospectively deemed inappropriate transfers, accounting for mean delay to exploration of 136.4 minutes (range 100-190)
  • For patients found to have testicular torsion, on comparison of referral source (transfer versus non-transfer patients), the odds ratio of risk of progression to orchidectomy was 3.42 (95% CI 0.79-14.85), p value = 0.135 (Fisher’s exact test, see table 1)

Table 1. Fisher’s exact test – torted transfer vs. torted non-transfer patients

 

Orchidectomy

No orchidectomy

Row subtotals

Transferred torsion

6

7

13

Non-transferred torsion

5

20

25

Column subtotals

11

27

38 (grand total)

 














Conclusion

Inappropriate transfers within this regional network remain a significant issue. Progression to orchidectomy is a multifactorial process, however unnecessary delays in scrotal exploration due to transfer may lead to increased risk of orchidectomy. Transfer protocols within regional networks must be clear to ensure safe practice and accountability.


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