ESPU Congress 2018 - Abstract Book

100

CONGRESS OF THE ESPU

S12: GENITALIA 2

Moderators: Nicolas Kalfa (France), TBA

ESPU Meeting on Thursday 12, April 2018, 16:34–17:14

16:34–16:37

S12-1 (PP)

DEVELOPMENT OF A NOVEL SCORING SYSTEM FOR

DIAGNOSIS OF TESTICULAR TORSION "CLINICAL

& RADIOGRAPHIC EXPLORATION OF SUSPECTED

TORSION" (CREST)

Tariq Osman ABBAS

, Mansour ALI

and Abdelrahman ELKADHI

1) Hamad General Hospital, Pediatric Surgery, Doha, QATAR - 2) Hamad Medical Corporation, Pediatric Surgery

Department, Doha, QATAR

PURPOSE

We introduce a novel scoring for diagnosing testicular Torsion in children; The Clinical &Radiographic

Exploration of Suspected Torsion (CREST) which uses urological history, physical examination and

Doppler ultrasound findings to assess risk of Testicular torsion preoperatively. Parameters include:

sudden pain (2 points), testis swelling (1 points), vomiting (1 point), heterogenous testis (3 points),

hydrocele (1 point) and absent vascularity (2 points). We assessed the usefulness of the CREST

score when determined by pediatric surgeons mirroring emergency room evaluation of acute scrotal

pain.

MATERIAL AND METHODS

Children following surgical scrotal exploration for acute scrotum over the study period were retro-

spectively enrolled in this study. After retrieving basic history, physical examination findings, two

independent pediatric radiologists blinded to the intra-operative findings reevaluated the imaging

of all patients in order to calculate CREST score. All data were captured into REDCap™ and ROC

curves were used to evaluate the diagnostic usefulness of CREST.

RESULTS

Of 65 patients (mean age 10.3 years) 44 (13.0 years) had torsion. CREST score cutoff values

of 0 and 10 derived from ROC analysis identified 21 high, 37 intermediate and 7 low risk cases

(positive predictive value 97.5 %, negative predictive value 99 %).

CONCLUSIONS

CREST score assessed by pediatric surgeons and radiologists is accurate. Low risk patients do

not require surgical exploration. High risk patients can proceed to surgery, with > 50 % avoiding

negative exploration. Surgical personnel may be able to calculate CREST score to guide immediate

surgical intervention and help reducing morbidity and costs of negative surgical explorations.