Testicular Torsion in Patients With Intellectual and Developmental Disabilities

Patients with intellectual/developmental disabilities are at risk of delayed diagnosis of testicular torsion due to their inability to effectively communicate their symptoms. We identified males ages 1 to 18 years with testicular torsion between January 1, 2015 and December 31, 2020, focusing on patients with intellectual and/or developmental disabilities. Of the 140 patients with testicular torsion, 5 (3.6%) patients exhibited intellectual/developmental disabilities with an inability to effectively verbalize testicular/groin/scrotal pain. The patients with intellectual/developmental disabilities underwent more orchiectomies (5/5, 100%, P = .009) and had a longer duration of symptoms (median = 48 hours, P = .047) compared to those without intellectual/developmental disabilities (51/135, 38% and median = 9 hours, respectively) (51/134, 38%) ( P = .038). Parents and other caregivers of males with intellectual/developmental disabilities who are unable to adequately verbalize their testicular/groin/scrotal pain should be cognizant of the signs and symptoms associated with testicular torsion, perform a genitalia examination, and seek an immediate evaluation to diagnose and treat this urgent condition.

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Pediatric Trauma-Induced Testicular Torsion: A Surgical Emergency

Urologia Internationalis ◽

10.1159/000511747 ◽

2020 ◽

pp. 1-4

Author(s):

Haijun Zhong ◽

Yunli Bi

Keyword(s):

Testicular Torsion ◽

Tertiary Care ◽

Pediatric Trauma ◽

Delayed Diagnosis ◽

Retrospective Chart Review ◽

Duration Of Symptoms ◽

Testicular Trauma ◽

Genital Trauma ◽

Tertiary Care Institution ◽

The Mean

Objective: To evaluate the features of testicular torsion (TT) resulting from minor groin trauma and to raise the awareness of trauma-induced testicular torsion (TITT). Methods: This is a retrospective chart review of patients presenting with TT resulting from minor genital trauma that was performed from January 2010 to December 2018 at a single tertiary care institution. The demographic, clinical, and perioperative characteristics, as well as data on follow-up and complications, were analyzed. Results: Of the 155 patients treated for TT, 15 were included in this study. The average age of the patients was 10.3 years (range: 3.2–13.3 years). All patients experienced a direct scrotal trauma and subsequently presented with an ipsilateral scrotal or testicular pain secondary to the twisted testicle. Six patients were misdiagnosed as having scrotal inflammation or hematoma, and all were initially treated at local hospitals. The mean duration of symptoms before hospitalization was 138 h (range: 5–504 h). The mean degree of torsion was 390° (range: 180–720°). The testicular salvation rate, at 33%, was poor. No serious postoperative complications or recurrences of TT was observed. Conclusions: TITT is a rare entity and still has delayed diagnosis. This may subsequently lead to a low testicular salvation rate. Emergency surgeons, especially in local hospitals, should be aware of the possibility of TT following testicular trauma in pediatric patients. Improving the parents’ awareness regarding TT is also important.

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Audiological and Other Factors Influencing Serious Injury From Falls in Adults With Intellectual and Developmental Disabilities

Perspectives of the ASHA Special Interest Groups ◽

10.1044/2021_persp-21-00061 ◽

2021 ◽

pp. 1-7

Author(s):

Steven M. Doettl ◽

Kandace L. Turner ◽

Patrick N. Plyler ◽

Nina Thomas ◽

Allyson Lambert ◽

...

Keyword(s):

At Risk ◽

Developmental Disabilities ◽

Intellectual And Developmental Disabilities ◽

Aggressive Behaviors ◽

Intrinsic Factors ◽

Impaired Mobility ◽

Visual Deficits ◽

Compulsive Behaviors ◽

History Of ◽

Serious Injury

Purpose Falls in adults with intellectual and developmental disabilities (IDDs) are a challenge for the organizations responsible for their management and care. This study represents the initiation of a program to identify, manage, and rehabilitate individuals at risk for falls in this population. Method A retrospective analysis of an active database was provided by the East Tennessee Regional Office of the Department of Intellectual and Developmental Disabilities. The data from 1,652 reportable falls from state-contracted support agencies over the calendar years of 2016–2018 were analyzed using chi-square and decision tree analyses for a dependent variable of serious injury and independent variables consisting of hearing deficits, impaired mobility including balance and vestibular deficits, enrollment in current physical therapy services for impaired mobility, staff instructions present for individuals at risk for falls, staff instructions followed, falls training for the supporting staff, current fall prevention plan in place, aggressive or compulsive behaviors, history of falls, medical conditions, visual deficits, familiar environments, adaptive equipment, intrinsic and extrinsic factors, medication change/side effects, obesity, and repeat falls. Results Significant factors included age, aggressive/compulsive behaviors, physical therapist (PT) services, balance deficits, and intrinsic factors. Post hoc analysis also indicated individuals receiving PT with a history of falls increased their risk of serious injury in unfamiliar environments. Individuals not receiving PT and exhibiting aggressive behaviors increased their risk of serious injury with visual deficits. For individuals not receiving PT services and not exhibiting aggressive behaviors, intrinsic factors increased the risk of serious injury. Conclusions These results describe the characteristics that can predict an increased risk for serious injury from a fall in an adult community-dwelling population with IDDs. These data can be used to implement changes to reduced injury from falls, including improved identification of undiagnosed vestibular deficits and assessment for the need for vestibular rehabilitation.

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MP014: What ultrasonography characteristics predict surgical intervention for children with testicular torsion?

CJEM ◽

10.1017/cem.2016.155 ◽

2016 ◽

Vol 18 (S1) ◽

pp. S71-S71 ◽

Cited By ~ 1

Author(s):

A.E. Shefrin ◽

B. Ritcey ◽

J.J. Perry ◽

M. Woo

Keyword(s):

Blood Flow ◽

Likelihood Ratio ◽

Testicular Torsion ◽

Surgical Intervention ◽

Point Of Care Ultrasound ◽

Scrotal Pain ◽

Duration Of Symptoms ◽

Predictive Values ◽

Ultrasound Findings ◽

Whirlpool Sign

Introduction: The timely diagnosis and treatment of testicular torsion is essential as a longer duration of symptoms is correlated with testicular necrosis and infertility. Ultrasound imaging assists in separating this diagnosis from other causes of acute scrotal pain. Our objective was to characterize which ultrasound findings predicted surgical intervention. Methods: We performed a retrospective health records review of all patients, ages 0-17 years that presented to the emergency department of the Children’s Hospital of Eastern Ontario over a 5-year period (2009-14) with scrotal pain <24 hours duration who were assessed by an emergency physician (EP) and received a testicular ultrasound by the Diagnostic Imaging Department. Patients’ records and ultrasound reports were reviewed by two reviewers who recorded ultrasound findings, times of EP assessment, ultrasound and surgical intervention in a standardized data extraction form. Sensitivity, specificity and positive and negative predictive values were calculated for the ultrasound findings. Results: 190 patients were analyzed of which 34 had a final diagnosis of testicular torsion (mean age 11.5 years, range 0-17.3). The mean time from EP assessment to ultrasound was 67.6 minutes (95%CI 50.5-84.6) during the daytime (800-2159) and 83.2 minutes (95%CI 36.7-130.4) for overnight presentations (2200-759). The absence of blood flow on colour Doppler ultrasound of the affected testicle was the best predictor of surgical intervention (sensitivity=94.1% [95%CI 80.3%-99.3%], specificity=99.4% [95%CI 96.5%-99.9%], positive likelihood ratio=146.8 [95%CI 20.7-1037.7] and negative likelihood ratio=0.06 [95%CI 0.02-0.23]. Other ultrasound findings that help rule in testicular torsion were the presence of a heterogeneous testicle on the symptomatic side (specificity=91.0% [95%CI 85.4%-95.0%] and the presence of the whirlpool sign (specificity=99.4% [95%CI 96.5%-99.9%]). Conclusion: The absence of blood flow on ultrasound is the best ultrasound finding for predicting surgical management of testicular torsion. Neither a heterogeneous testicle nor whirlpool sign had strong enough sensitivity to warrant their independent use. Future studies, such as those utilizing point of care ultrasound by EPs, should be conducted to study the affect on delays in treatment.

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Acute scrotum: differential diagnosis and treatment

Revista de Medicina ◽

10.11606/issn.1679-9836.v97i3p278-282 ◽

2018 ◽

Vol 97 (3) ◽

pp. 278-282

Author(s):

João Arthur Brunhara Alves Barbosa ◽

Marco Antonio Arap

Keyword(s):

Blood Flow ◽

Differential Diagnosis ◽

Testicular Torsion ◽

Color Doppler ◽

Testicular Tumor ◽

Signs And Symptoms ◽

Clinical Syndrome ◽

Acute Scrotum ◽

Viral Etiology ◽

Scrotal Pain

Acute scrotum (AS) is a clinical syndrome characterized by scrotal pain of acute onset, often accompanied by scrotal swelling and other local and systemic signs and symptoms. It may be the initial presentation of several diseases including testicular torsion, orchitis, epididymitis, hydatid torsion, strangulated hernia and, less frequently, scrotal hematoma and testicular tumor. In the setting of emergency services, physicians should be extremely careful with the possibility of testicular torsion. This condition consists in the torsion of the spermatic cord, leading to an interruption of the testicular blood flow, with ischemia and ultimately necrosis. It is associated with acute severe pain, nausea, absence of the cremasteric reflex, and a high-riding testis. Physical examination may help diagnosis. However, a color Doppler ultrasound of the scrotum is usually required for a definitive diagnosis. Ultrasound will reveal a reduction or no blood flow to the affected testis; surgical treatment is mandatory and should be performed as early as possible. A differential diagnosis is orchiepididymitis. It may be of viral etiology in early childhood and bacterial after the beginning of sexual activity. The most specific sign associated with this condition is the relief of pain after elevation of the testis, known as Prehn’s sign. Treatment for bacterial cases requires antibiotics, while cases of viral etiology require only symptomatics. Hydatid torsion, including torsion of appendix testicularis and appendix epididymis may mimic testicular torsion but on ultrasound, blood flow is preserved, and a twisted appendix is often seen. Treatment for this condition consists only in symptomatic control. Testicular torsion should be treated as early as possible, since a delay of 6 hours may result in organ loss. Surgery consists of bilateral orchiopexy in case of a viable testicle and orchiectomy of a necrotic organ, always with fixation of the contralateral testicle.

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Comparison of demographic and clinical characteristics in distinguishing testicular torsion from torsion of the appendix testis

10.21203/rs.3.rs-461129/v1 ◽

2021 ◽

Author(s):

Zlatan Zvizdic ◽

Amila Aganovic ◽

Emir Milisic ◽

Asmir Jonuzi ◽

Denisa Zvizdic ◽

...

Keyword(s):

Abdominal Pain ◽

Clinical Characteristics ◽

Testicular Torsion ◽

Pediatric Population ◽

Color Doppler ◽

Medical Emergency ◽

Acute Scrotum ◽

Scrotal Pain ◽

Duration Of Symptoms ◽

Appendix Testis

Abstract Purpose The acute scrotum (AS) in the pediatric population is a medical emergency. The most common causes of AS include testicular torsion (TT) and torsion of the appendix testis (TAT). Their distinction may be clinically challenging. The purpose of our study was to compare demographic and clinical characteristics of the pediatric cases of TT and TAT and thus provide clinical evidence for distinguishing these two conditions. Methods We retrospectively analyzed all children ≤ 16 years who underwent surgical exploration for AS. The patients were divided into Group 1 or TT and Group 2 or TAT groups. Results Ninety patients were included in the study (24 with TT and 66 with TAT). Patients with TT were significantly older than those with TAT (p < 0.001). The peak incidence of TT was in the age of 12–16 years (p < 0.001), whereas the peak of TAT was in the age group of 7–11 years (p < 0.001). Scrotal pain was more prevalent in patients with TAT (p = 0.02), whereas systemic signs (nausea/vomiting and abdominal pain) affected more frequently the TT patients (p = 0.003 and p < 0.001, respectively). The mean duration of symptoms was significantly longer in the TAT group than in the TT group (p < 0.001). Color-Doppler Ultrasound (CDUS) findings of absent or decreased testicular blood flow in the affected testis strongly favored the diagnosis of TT (p < 0.001). Conclusion Our data indicate that the older age, shorter duration of symptoms, systemic signs (nausea/vomiting and abdominal pain), and characteristics CDUS findings can help distinguish between the two most common acute scrotum causes.

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