title: Testicular Torsion Presentation Trends before and after Pediatric Urology Subspecialty Certification.
abstract: We examined testicular torsion presentation and referral trends at our institution before and after pediatric urology subspecialty certification.
  
  
  
  We reviewed patients with testicular torsion presenting directly to our pediatric hospital emergency department ("direct") or transferred urgently from an outside institution ("referred") who underwent detorsion and orchiopexy or orchiectomy between 2005 and 2015. Presentations were considered acute (less than 24 hours) or delayed (24 hours or greater) based on time from symptom onset. Primary outcomes were case volume and presentation trends through time. Secondary outcomes were effect of presenting location and transport variables on orchiectomy rate.
  
  
  
  Incidence of testicular torsion increased from 15 cases in 2005 to 32 in 2015. Annual incidence of direct cases increased slightly during the study period from 12 to 17, whereas incidence of referred cases increased from 3 in 2005 to 15 in 2015. Proportion of referred acute cases markedly increased from precertification (4 of 63, 6.3%) to postcertification period (42 of 155, 27.1%; p <0.01). The majority of referred cases (59 of 83, 71.1%) presented during weekday nights or weekends compared to a minority of direct cases (59 of 135, 43.7%; p <0.01). Orchiectomy rates were similar between direct and referred cases across all study periods and were not significantly impacted by presentation location, transport distance or transport modality (all p >0.05).
  
  
  
  Patients with testicular torsion have been increasingly referred to our institution, with the majority presenting on weekday nights and weekends. Our data do not support routinely transferring these patients to dedicated pediatric hospitals.
authors.affiliation: Division of Pediatric Urology, Children's National Health System, Washington, D.C.. Electronic address: cbayne3@childrensnational.org.
authors.forename: Christopher E
authors.initials: CE
authors.lastname: Bayne
authors.affiliation: Department of Urology, George Washington University, Washington, D.C.
authors.forename: Patrick T
authors.initials: PT
authors.lastname: Gomella
authors.affiliation: Department of Urology, George Washington University, Washington, D.C.
authors.forename: John M
authors.initials: JM
authors.lastname: DiBianco
authors.affiliation: Division of Pediatric Urology, Children's National Health System, Washington, D.C.
authors.forename: Tanya D
authors.initials: TD
authors.lastname: Davis
authors.affiliation: Division of Pediatric Urology, Children's National Health System, Washington, D.C.
authors.forename: Hans G
authors.initials: HG
authors.lastname: Pohl
authors.affiliation: Division of Pediatric Urology, Children's National Health System, Washington, D.C.
authors.forename: H G
authors.initials: HG
authors.lastname: Rushton
mesh_terms: D000293:Adolescent; D002568:Certification; D002648:Child; D002675:Child, Preschool; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D008297:Male; D009919:Orchiectomy; D056126:Orchiopexy; D010372:Pediatrics / Q000592:standards*; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013086:Spermatic Cord Torsion / Q000453:epidemiology* / Q000601:surgery*; D014572:Urology / Q000592:standards*; D055815:Young Adult
keywords: certification; pediatrics; referral and consultation; spermatic cord torsion; urology