title: Predictivity of Clinical Findings and Doppler Ultrasound in Pediatric Acute Scrotum.
abstract: OBJECTIVE
  To evaluate the role of Doppler ultrasonography (DUS) in diagnosing pediatric testicular torsion (TT), and its diagnostic accuracy, and helping clinicians increase specificity and decrease negative exploration rates.
  
  
  METHODS
  We performed a retrospective study of all consecutive patients with acute testicular symptoms referring to our pediatric emergency department (ED) from January 2010 to December 2013.
  
  
  RESULTS
  We analyzed 1091 patients, with a mean age of 9 years. DUS was performed in 498 patients (40.8%); 107 patients (8.8%) underwent surgery and 41 patients (3.3%) had a TT. The following clinical findings were collected: presence of scrotal pain, erythema and swelling, spermatic cord pain and abnormal cremasteric reflex. The clinical findings significantly associated with TT were spermatic cord pain (OR = 37, 95% CI: 11.9-111.1, P &lt; .001) and abnormal cremasteric reflex (OR = 47.6, 95% CI: 13.5-166.6, P &lt; .001); the presence of swelling resulted confounding (OR = 2.3, 95% CI: 0.7-8.4, P &lt; .001). Scrotal pain was not significantly associated with TT (P = .9), while erythema made TT unlikely (OR = 0.22, 95% CI: 0.07-0.7, P = .0445). In all cases the DUS significantly increased the predictivity.
  
  
  CONCLUSIONS
  TT was present in 3.3% of patients presenting with testicular symptoms. The predictivity based on clinical findings resulted high and the negative exploration rate for TT was 62%. DUS increased the predictivity in all patients.&nbsp.
authors: Department of Pediatric General, Thoracic and Minimally Invasive Surgery, Regina Margherita Children's Hospital, Torino, Italy.
authors: Riccardo
authors: R
authors: Lemini
authors: Department of Pediatric General, Thoracic and Minimally Invasive Surgery, Regina Margherita Children's Hospital, Torino, Italy.
authors: Riccardo
authors: R
authors: Guanà
authors: Department of Pediatric General, Thoracic and Minimally Invasive Surgery, Regina Margherita Children's Hospital, Torino, Italy.
authors: Nicola
authors: N
authors: Tommasoni
authors: Department of Public Health and Pediatric Sciences, University of Torino, Torino, Italy.
authors: Alessandro
authors: A
authors: Mussa
authors: Division of Pediatric Radiology, Regina Margherita Children's Hospital, Torino, Italy.
authors: Gianpaolo
authors: G
authors: Di Rosa
authors: Department of Pediatric General, Thoracic and Minimally Invasive Surgery, Regina Margherita Children's Hospital, Torino, Italy.
authors: Jurgen
authors: J
authors: Schleef
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D008297:Male; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012611:Scrotum; D013086:Spermatic Cord Torsion / Q000000981:diagnostic imaging*; D018608:Ultrasonography, Doppler