Background: Ultrasound (USS) is commonly used in evaluating paediatric acute scrotum, but its standalone diagnostic reliability, especially in prepubertal children, remains uncertain, particularly in low-resource settings lacking formal protocols. Aim: To assess the diagnostic performance of ultrasound and identify clinical predictors of testicular torsion in prepubertal children presenting with acute scrotum. Methods: A retrospective study was conducted at the national tertiary centre in Brunei, including children under 12 years presenting with acute scrotum between January 2017 and December 2024. Data on clinical signs, ultrasound findings, and final diagnoses were reviewed. Ultrasound findings were categorised as positive, negative, or inconclusive and compared with surgical or clinical follow-up outcomes. Diagnostic metrics were calculated, and clinical predictors were analysed. Results: Of 67 children, 13 (19%) had testicular torsion, 36 (54%) had epididymitis, and 18 (27%) had other diagnoses. Among 51 ultrasounds performed, the positive predictive value was 69%, the negative predictive value was 74%, and the overall accuracy was 73%. Absent cremasteric reflex and high-riding testis were significantly associated with torsion. Conclusion: In this prepubertal cohort, ultrasound alone was not sufficiently reliable to diagnose testicular torsion. A structured pathway integrating clinical scoring with selective imaging is recommended to improve triage and reduce diagnostic uncertainty in low-resource settings.
Shoaib et al. (Wed,) studied this question.