title: Clinical predictors of testicular torsion in children.
abstract: OBJECTIVE
  To distinguish the prognostic factors that decrease the probability of a negative exploration for "acute scrotum." In some institutes, patients with "acute scrotum" undergo immediate exploration after clinical evaluation. Because testicular torsion (TT) accounts only for a fraction of these cases, most infants can be treated conservatively.
  
  
  METHODS
  We performed a retrospective study of all patients treated at our institute from January 2008 to December 2009 for the diagnosis of "acute scrotum." Differences between groups were calculated using the chi-square test or analysis of variance and Mann-Whitney-Wilcoxon test for univariate or multivariate analysis, expressed as odds ratios (ORs) and 95% confidence intervals (CIs).
  
  
  RESULTS
  The data from 138 patients were analyzed. The mean age was 9 years, 8 months. Of the 138 patients, 19 (13.8%) had TT. This group was compared with the boys without TT at exploration. The patients with TT were older on average (11 years, 1 month vs 9 years, 1 month, p = .035). Pain for <24 hours (OR 4.2, 95% CI 1.3-13.4), nausea and/or vomiting (OR 21.6, 95% CI 4.9-93.4), abnormal cremasteric reflex (OR 4.8 95% CI 0.7-35.2), and a high position of the testis (OR 18.0 95% CI 1.8-177.1) were associated with an increased likelihood of torsion. In the group of boys with ≥ 2 of these findings present, 100% had TT at exploration, with 0% false-positive results.
  
  
  CONCLUSIONS
  TT is uncommon among the group of boys treated for "acute scrotum." In particular, a pain duration <24 hours, nausea or vomiting, a high position of the testis, and an abnormal cremasteric reflex had a positive prognostic value for TT. A clinical score might help to avoid unnecessary explorations. In the future, we intend to test the diagnostic set described combined with ultrasonography.
authors.affiliation: Department of Pediatric Surgery, Hamburg University UKE-Medical School, University Children's Hospital Altona, Hamburg, Germany. michboettcher@gmail.com
authors.forename: Michael
authors.initials: M
authors.lastname: Boettcher
authors.forename: Robert
authors.initials: R
authors.lastname: Bergholz
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Krebs
authors.forename: Katharina
authors.initials: K
authors.lastname: Wenke
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Aronson
mesh_terms: D017677:Age Distribution; D016009:Chi-Square Distribution; D002648:Child; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D012611:Scrotum / Q000601:surgery*; D013086:Spermatic Cord Torsion / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery