title: Transscrotal Near Infrared Spectroscopy as a Diagnostic Test for Testis Torsion in Pediatric Acute Scrotum: A Prospective Comparison to Gold Standard Diagnostic Test Study.
abstract: A rapid test for testicular torsion in children may obviate the delay for testicular ultrasound. In this study we assessed testicular tissue percent oxygen saturation (%StO2) measured by transscrotal near infrared spectroscopy as a diagnostic test for pediatric testicular torsion.
  
  
  
  This was a prospective comparison to a gold standard diagnostic test study that evaluated near infrared spectroscopy %StO2 readings to diagnose testicular torsion. The gold standard for torsion diagnosis was standard clinical care. From 2013 to 2015 males with acute scrotum for more than 1 month and who were less than 18 years old were recruited. Near infrared spectroscopy %StO2 readings were obtained for affected and unaffected testes. Near infrared spectroscopy Δ%StO2 was calculated as unaffected minus affected reading. The utility of near infrared spectroscopy Δ%StO2 to diagnose testis torsion was described with ROC curves.
  
  
  
  Of 154 eligible patients 121 had near infrared spectroscopy readings. Median near infrared spectroscopy Δ%StO2 in the 36 patients with torsion was 2.0 (IQR -4.2 to 9.8) vs -1.7 (IQR -8.7 to 2.0) in the 85 without torsion (p=0.004). AUC for near infrared spectroscopy as a diagnostic test was 0.66 (95% CI 0.55-0.78). Near infrared spectroscopy Δ%StO2 of 20 or greater had a positive predictive value of 100% and a sensitivity of 22.2%. Tanner stage 3-5 cases without scrotal edema or with pain for 12 hours or less had an AUC of 0.91 (95% CI 0.86-1.0) and 0.80 (95% CI 0.62-0.99), respectively.
  
  
  
  In all children near infrared spectroscopy readings had limited utility in diagnosing torsion. However, in Tanner 3-5 cases without scrotal edema or with pain 12 hours or less, near infrared spectroscopy discriminated well between torsion and nontorsion.
authors.affiliation: University of Texas Southwestern Medical Center, Dallas, Texas; Children's Health, Dallas, Texas. Electronic address: bruce.schlomer@childrens.com.
authors.forename: Bruce J
authors.initials: BJ
authors.lastname: Schlomer
authors.affiliation: Children's Hospital of East Ontario, Ottawa, Ontario.
authors.forename: Melise A
authors.initials: MA
authors.lastname: Keays
authors.affiliation: Phoenix Children's Hospital, Phoenix, Arizona.
authors.forename: Gwen M
authors.initials: GM
authors.lastname: Grimsby
authors.affiliation: Mayo Clinic, Rochester, Minnesota.
authors.forename: Candace F
authors.initials: CF
authors.lastname: Granberg
authors.affiliation: Nationwide Children's Hospital, Columbus, Ohio.
authors.forename: Daniel G
authors.initials: DG
authors.lastname: DaJusta
authors.affiliation: University of Texas Southwestern Medical Center, Dallas, Texas; Children's Health, Dallas, Texas.
authors.forename: Vani S
authors.initials: VS
authors.lastname: Menon
authors.affiliation: Children's Health, Dallas, Texas.
authors.forename: Lauren
authors.initials: L
authors.lastname: Ostrov
authors.affiliation: University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Kunj R
authors.initials: KR
authors.lastname: Sheth
authors.affiliation: Children's Health, Dallas, Texas.
authors.forename: Martinez
authors.initials: M
authors.lastname: Hill
authors.affiliation: Children's Health, Dallas, Texas.
authors.forename: Emma J
authors.initials: EJ
authors.lastname: Sanchez
authors.affiliation: University of Texas Southwestern Medical Center, Dallas, Texas; Children's Health, Dallas, Texas.
authors.forename: Clanton B
authors.initials: CB
authors.lastname: Harrison
authors.affiliation: University of Texas Southwestern Medical Center, Dallas, Texas; Children's Health, Dallas, Texas.
authors.forename: Micah A
authors.initials: MA
authors.lastname: Jacobs
authors.affiliation: Children's Health, Dallas, Texas.
authors.forename: Rong
authors.initials: R
authors.lastname: Huang
authors.affiliation: Ankara Üniversitesi Tıp Fakültesi, Ankara, Turkey.
authors.forename: Berk
authors.initials: B
authors.lastname: Burgu
authors.affiliation: University of Texas Southwestern Medical Center, Dallas, Texas; Children's Health, Dallas, Texas.
authors.forename: Halim
authors.initials: H
authors.lastname: Hennes
authors.affiliation: University of Texas Southwestern Medical Center, Dallas, Texas; Children's Health, Dallas, Texas.
authors.forename: Linda A
authors.initials: LA
authors.lastname: Baker
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004487:Edema / Q000150:complications; D004636:Emergency Service, Hospital; D006801:Humans; D007223:Infant; D008297:Male; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D012611:Scrotum; D012680:Sensitivity and Specificity; D019265:Spectroscopy, Near-Infrared; D013086:Spermatic Cord Torsion / Q000000981:diagnostic imaging*
keywords: diagnostic techniques and procedures; near-infrared; pediatrics; spectroscopy; spermatic cord torsion