title: History and physical examination findings predictive of testicular torsion: an attempt to promote clinical diagnosis by house staff.
abstract: OBJECTIVE
  To standardize the history and physical examination of boys who present with acute scrotum and identify parameters that best predict testicular torsion.
  
  
  METHODS
  Over a 5-month period, a standardized history and physical examination form with 22 items was used for all boys presenting with scrotal pain. Management decisions for radiological evaluation and surgical intervention were based on the results. Data were statistically analyzed in correlation with the eventual diagnosis.
  
  
  RESULTS
  Of the 79 boys evaluated, 8 (10.1%) had testicular torsion. On univariate analysis, age, worsening pain, nausea/vomiting, severe pain at rest, absence of ipsilateral cremaster reflex, abnormal testicular position and scrotal skin changes were statistically predictive of torsion. After multivariate analysis and adjusting for confounding effect of other co-existing variables, absence of ipsilateral cremaster reflex (P < 0.001), nausea/vomiting (P < 0.05) and scrotal skin changes (P < 0.001) were the only consistent predictive factors of testicular torsion.
  
  
  CONCLUSIONS
  An accurate history and physical examination of boys with acute scrotum should be primary in deciding upon further radiographic or surgical evaluation. While several forces have led to less consistent overnight resident staffing, consistent and reliable clinical evaluation of the acute scrotum using a standardized approach should reduce error, improve patient care and potentially reduce health care costs.
authors: Division of Pediatric Urology, Cohen Children's Medical Center of New York, North Shore-Long Island Jewish Health System, Long Island, Lake Success, NY 11042, USA.
authors: Arun
authors: A
authors: Srinivasan
authors: Nadya
authors: N
authors: Cinman
authors: Kevin M
authors: KM
authors: Feber
authors: Jordan
authors: J
authors: Gitlin
authors: Lane S
authors: LS
authors: Palmer
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D002648:Child; D003937:Diagnosis, Differential; D004636:Emergency Service, Hospital / Q000592:standards; D006801:Humans; D008297:Male; D008487:Medical History Taking / Q000379:methods* / Q000592:standards*; D008505:Medical Staff, Hospital / Q000592:standards*; D010146:Pain / Q000175:diagnosis; D010808:Physical Examination / Q000379:methods* / Q000592:standards*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011787:Quality of Health Care; D012611:Scrotum; D012680:Sensitivity and Specificity; D013086:Spermatic Cord Torsion / Q000175:diagnosis*