title: Pediatric testicular torsion epidemiology using a national database: incidence, risk of orchiectomy and possible measures toward improving the quality of care.
abstract: OBJECTIVE
  Testicular torsion causes considerable morbidity in the pediatric population but the societal burden is poorly quantified. We determined the modern incidence of testicular torsion as well as the current rates of orchiectomy and attempted testicular salvage, and identified the risk factors for testicular loss.
  
  
  METHODS
  A cohort analysis was performed of 2,443 boys (age 1 month to less than 18 years) and 152 newborns who underwent surgery for testicular torsion in the 2000, 2003 and 2006 Healthcare Cost and Utilization Project Kids' Inpatient Database. Patient and hospital characteristics predictive of orchiectomy vs attempted testicular salvage were analyzed.
  
  
  RESULTS
  There was a bimodal distribution of testicular torsion with peaks in the first year of life and in early adolescence. The overall mean age ± SD at presentation was 10.6 ± 5.8 years. The estimated yearly incidence of testicular torsion for males younger than 18 years old was 3.8 per 100,000. Orchiectomy was performed in 41.9% of boys undergoing surgery for torsion. The adjusted odds ratio for orchiectomy was highest for children in the youngest age quartile (younger than 10 years old, OR 1.58, 95% CI 1.25-2.00). Additional independent predictors of orchiectomy included Medicaid insurance (OR 1.39, 95% CI 1.14-1.69), black race (OR 1.33, 95% CI 1.04-1.71), nonemergency room admission source (OR 1.97, 95% CI 1.60-2.42) and surgery at a children's hospital or unit (OR 1.64, 95% CI 1.36-1.98).
  
  
  CONCLUSIONS
  Testicular torsion is uncommon but the rate of orchiectomy is high, especially in the youngest patients.
authors.affiliation: Department of Urology, Northwestern University, Chicago, Illinois 60611, USA. lzhao1@gmail.com
authors.forename: Lee C
authors.initials: LC
authors.lastname: Zhao
authors.forename: Timothy B
authors.initials: TB
authors.lastname: Lautz
authors.forename: Joshua J
authors.initials: JJ
authors.lastname: Meeks
authors.forename: Max
authors.initials: M
authors.lastname: Maizels
mesh_terms: D000293:Adolescent; D017677:Age Distribution; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D006801:Humans; D015994:Incidence; D007223:Infant; D007348:Insurance, Health / Q000706:statistics & numerical data; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data; D016017:Odds Ratio; D009919:Orchiectomy / Q000706:statistics & numerical data*; D011787:Quality of Health Care; D012307:Risk Factors; D012959:Socioeconomic Factors; D013086:Spermatic Cord Torsion / Q000453:epidemiology* / Q000601:surgery*; D014481:United States / Q000453:epidemiology