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POCUS accurate for diagnosis of testicular torsion in kids

07 Jan 2020

Point-of-care ultrasound (POCUS) in emergency settings accurately detects testicular torsion in children, a recent study has found.

Researchers reviewed the medical charts of 120 paediatric patients (mean age, 10 years) who presented to the emergency department and received POCUS. The primary study outcome was POCUS accuracy in the diagnosis of acute scrotal testicular torsion.

Twelve patients received a final diagnosis of testicular torsion, resulting in an overall prevalence rate of 10 percent. Two initial paediatric emergency department (PED) experts disagreed on eight POCUS categorizations and on seven final diagnoses. A third POCUS expert was brought in to resolve the disputes.

When delivered by PED physicians, POCUS demonstrated excellent accuracy for diagnosing testicular torsion. For instance, the resulting sensitivity and specificity values were 100 percent (95 percent confidence interval [CI], 73.5–100) and 99.1 percent (95 percent CI, 95.0–100), respectively. The positive and negative predictive values were likewise high, at 92.3 percent and 100 percent, respectively.

Notably, POCUS missed no diagnosis of testicular torsion. All 12 true-positive cases were correctly detected. There was one false-positive case, however, which was ultimately given a final diagnosis of torsion of the appendix testis.

“Point-of-care ultrasound by PED may be accurate in diagnosing testicular torsion of the children with acute scrotum. Further studies are needed on the ability of PED POCUS to detect other causes of acute scrotum and on whether PED POCUS can improve outcomes and resource utilization in these children,” said the researchers.

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