title: Standardized education and parental awareness are lacking for testicular torsion.
abstract: BACKGROUND
  Testicular torsion leads to orchiectomy in 30-50% of cases, which may cause psychological upset and parental guilt over a potentially avertable outcome. Presentation delay is an important modifiable cause of orchiectomy; yet, families are not routinely educated about torsion or its urgency. The present study assessed parental knowledge regarding acute scrotal pain.
  
  
  METHODS
  An anonymous survey was distributed to parents in Urology and ENT offices, asking about their children's gender and scrotal pain history, urgency of response to a child's acute scrotal pain, and familiarity with testicular torsion.
  
  
  RESULTS
  Surveys of 479 urology and 59 ENT parents were analyzed. The results between the two were not statistically different. Among the urology parents, 34% had heard of testicular twisting/torsion, most commonly through friends, relatives or knowing someone with torsion (35%); only 17% were informed by pediatricians (Summary Figure). Parents presenting for a child's scrotal pain were significantly more likely to have heard of torsion (69%) than those presenting for other reasons (30%, OR 5.24, P < 0.0001). Only 13% of parents of boys had spoken with their children about torsion. Roughly three quarters of them would seek emergent medical attention - by day (75%) or night (82%) - for acute scrotal pain. However, urgency was no more likely among those who knew about torsion.
  
  
  CONCLUSIONS
  This was the first study to assess parental knowledge of the emergent nature of acute scrotal pain in a non-urgent setting, and most closely approximating their level of knowledge at the time of pain onset. It also assessed parents' hypothetical responses to the scenario, which was markedly different than documented presentation times, highlighting a potential area for improvement in presentation times. Potential limitations included lack of respondent demographic data, potential sampling bias of a population with greater healthcare knowledge or involvement, and assessment of parents only.
  
  
  CONCLUSIONS
  Parental knowledge of testicular torsion was lacking, suggesting both ineffective education in the well-child setting and inappropriately timed education during or after pain occurrence. Awareness was most commonly anecdotal or taught unreliably, as even familiar parents were no more likely to seek emergent attention. Therefore, standardized, effective parental education on testicular torsion and the need for prompt presentation is needed, as is improvement in the quality of information taught in the healthcare setting. Further assessment of knowledge among preadolescent and adolescent boys regarding testicular torsion is warranted. It is hopeful that pre-hospital delay may be minimized and greater rates of testicular salvageability may be achieved through these efforts.
authors.affiliation: Steven and Alexandra Cohen Children's Medical Center and the Arthur Smith Institute for Urology, North Shore-Long Island Jewish Health System, New York, USA. Electronic address: ariellafriedmanmd@gmail.com.
authors.forename: Ariella A
authors.initials: AA
authors.lastname: Friedman
authors.affiliation: Steven and Alexandra Cohen Children's Medical Center and the Arthur Smith Institute for Urology, North Shore-Long Island Jewish Health System, New York, USA.
authors.forename: Haris
authors.initials: H
authors.lastname: Ahmed
authors.affiliation: Steven and Alexandra Cohen Children's Medical Center and the Arthur Smith Institute for Urology, North Shore-Long Island Jewish Health System, New York, USA.
authors.forename: Jordan S
authors.initials: JS
authors.lastname: Gitlin
authors.affiliation: Steven and Alexandra Cohen Children's Medical Center and the Arthur Smith Institute for Urology, North Shore-Long Island Jewish Health System, New York, USA.
authors.forename: Lane S
authors.initials: LS
authors.lastname: Palmer
mesh_terms: D002648:Child; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D010290:Parents / Q000193:education; D057566:Self Report; D013086:Spermatic Cord Torsion
keywords: Health behavior; Health education; Spermatic cord torsion