Acute scrotum is a prevalent emergency presentation to emergency departments and urological services in Australia. The most significant diagnosis to consider is testicular torsion, which is diagnostically challenging and time-sensitive in preserving testicular viability and fertility. Ultrasound scrotum with colour doppler is indicated following surgical review in discerning equivocal cases where there is low clinical suspicion.1-3 This study examines the patterns of scrotal ultrasound referrals from ED for adult patients with suspected testicular torsion and its utility in resolving equivocal cases.

Ethical and Institutional approval was obtained (HREC: EX/2022/QWMS/91314) for this single-centre retrospective study, which involved 200 consecutive anonymized patients that underwent scrotal ultrasound between 1st January 2022 and 31st October 2022 at a Hospital in Brisbane, Australia. All adult patients who underwent a scrotal ultrasound in the emergency department for suspected testicular torsion were included. Paediatric patients, other referral reasons and non-ED sources were excluded. De-identified data was extracted via the electronic medical record including referral source, referral reason, whether a surgical consultation was made...

200 consecutive patients who underwent ultrasound scrotum were analysed. 150 out of 200 patients were excluded including 62 referred by ED for investigation other than torsion, 63 not referred by ED, 16 ED paediatric, and 7 cancelled/duplicate. A total of 50 adult emergency department patients who underwent ultrasound scrotum for suspected testicular torsion were included. The average age was 32.26 years. Urological consult was made in 43 (86%) out of 50 scans. Subsequent ultrasound scrotum was ordered for equivocal cases of low torsion clinical suspicion,...

This study demonstrated that ultrasound scrotum is critical in resolving equivocal cases in keeping with current local and national guidelines in Australia.1-3 Despite low clinical suspicion, expeditious surgical consult and ultrasound scrotum is mandatory in equivocal cases as in the 1 detected torsion in 50 patients. The findings correlate with recent TWIST score meta-analysis that demonstrated a missed torsion rate of 1.6/100 on clinical scoring alone.4

Institute EC. Testicular Torsion. Agency of Clinical Innovation. 2023. Available from: https://aci.health.nsw.gov.au/networks/eci/clinical/clinical-tools/urology/acute-scrotum/testicular-torsion RACS. Acute Scrotal Pain and Suspected Testicular Torsion. RACS. 2021. Available from: https://www.surgeons.org/-/media/Project/RACS/surgeons-org/files/position-papers/2018-02-06_gdl_fes-pst-002_acute_scrotal_pain_and_suspected_testicular_torsion.pdf?rev=e5680ba1862e4af0b0377b28eb4551fd&hash=E64ACA5DBEEBD7947282E57690702D6E Wang CL, Aryal B, Oto A, et al. ACR Appropriateness Criteria® Acute Onset ofScrotal Pain-Without Trauma, Without Antecedent Mass. Journal of the American College of Radiology. 2019;16(5, Supplement):S38-S43. doi:https://doi.org/10.1016/j.jacr.2019.02.016 https://www.sciencedirect.com/science/article/pii/S1546144019301565 Qin KR, Qu LG. Diagnosing with a TWIST: Systematic Review and Meta-Analysis of a Testicular Torsion Risk Score. 2022;208(1):62-70. doi:doi:10.1097/JU.0000000000002496 https://www.auajournals.org/doi/abs/10.1097/JU.0000000000002496