Aim: Delayed exploration in suspected testicular torsion leads to increased orchidectomy rates and the 2016 RCS commissioning guide for the management of paediatric torsion advocates that transfer from a secondary to a tertiary unit should be an exceptional occurrence.
We have previously reported data showing a statistically significant higher orchidectomy rate in boys transferred to our unit versus those presenting directly to our ED.
This single centre study retrospectively analyses the effect of implementation of an age cut-off for transfers on emergency scrotal explorations performed in a tertiary level paediatric surgery department.
Methods: For the period April 2008-December 2017 all patients who underwent emergency scrotal exploration under the care of paediatric surgery were identified. Clinical data were obtained from contemporaneous records.
From January 2017, it was agreed within our local clinical network that boys aged 5 or over (5+) with suspected torsion presenting to a secondary unit would be managed locally except in exceptional circumstances.
Results: From 2008-2016, 733 patients underwent emergency scrotal exploration. 333 (45%) attended our emergency department, 297 (41%) were referred from primary care and 96 (13%) were transferred from other hospitals. Of the transfers, 61 (64%) were 5+. A mean of 10.9 patients (7.0 patients 5+) were transferred per year.
From January to December 2017, 87 patients underwent emergency scrotal exploration. 46 (53%) attended our emergency department, 29 (33%) were referred from primary care and 10 (11%) were transferred from other hospitals. Of the transfers, 4 (40%) were 5+ (p=0.18).
Conclusion: Implementing an age cut-off for transfers from secondary units for suspected torsion should reduce delays in definitive management and increase exposure of adult surgical and urological trainees to paediatric torsion. Further work is needed to assess the effect on the management and outcomes of children who are now managed locally.