Mp40-03 Trans-Scrotal Near Infrared Spectroscopy in the Emergency Department to Diagnose Testicular Torsion in Pediatric Patients Presenting With Acute Scrotum

You have accessJournal of UrologyPediatrics: Testis & Varicoceles, Stones1 Apr 2015MP40-03 TRANS-SCROTAL NEAR INFRARED SPECTROSCOPY IN THE EMERGENCY DEPARTMENT TO DIAGNOSE TESTICULAR TORSION IN PEDIATRIC PATIENTS PRESENTING WITH ACUTE SCROTUM Bruce Schlomer, Melise Keays, Gwen Grimsby, Candace Granberg, Daniel DaJusta, Berk Bergu, Lauren Ostrov, Kunj Sheth, Martinez Hill, Emma Sanchez, Rong Huang, Clanton Harrison, Micah Jacobs, Helim Hennes, and Linda Baker Bruce SchlomerBruce Schlomer More articles by this author , Melise KeaysMelise Keays More articles by this author , Gwen GrimsbyGwen Grimsby More articles by this author , Candace GranbergCandace Granberg More articles by this author , Daniel DaJustaDaniel DaJusta More articles by this author , Berk BerguBerk Bergu More articles by this author , Lauren OstrovLauren Ostrov More articles by this author , Kunj ShethKunj Sheth More articles by this author , Martinez HillMartinez Hill More articles by this author , Emma SanchezEmma Sanchez More articles by this author , Rong HuangRong Huang More articles by this author , Clanton HarrisonClanton Harrison More articles by this author , Micah JacobsMicah Jacobs More articles by this author , Helim HennesHelim Hennes More articles by this author , and Linda BakerLinda Baker More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1185AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES A rapid and reliable means to discern testis torsion from other causes of acute scrotum in children would aid emergency department (ED) care and may obviate the need for testicular ultrasound (TUS). In this study the testicular tissue saturation of oxygen (StO2) measured by trans-scrotal near-infrared spectroscopy (NIRS) was assessed as a diagnostic test for pediatric testicular torsion. METHODS From 2013-2014, males with acute scrotum >2 months and <18 years old were prospectively enrolled in this NIH clinical trial. ED NIRS StO2 readings were obtained for affected and contralateral control normal testes and did not impact clinical care. Testis torsion was diagnosed by history, physical exam and TUS and confirmed at surgery. The utility of NIRS to diagnose testis torsion in pediatric patients in the ED was described using receiver operating characteristic (ROC) curves and by the sensitivity and specificity of useful cutoff values. RESULTS Of 167 patients enrolled, 139 were eligible and 44 had testis torsion. The average age was 11.1 years (range 0.6 - 17.9). Of the 139 patients, a NIRS reading in ED was attempted in 128 and obtained for both testis in 113. The NIRS ΔStO2 (StO2 normal testis minus StO2 affected testis) in patients with torsion was 6.2 (SD 17.2) compared to -3.4 (SD 9.7) in non-torsion patients (p<0.001). The area under the ROC curve for NIRS to diagnose torsion was 0.66 (95% CI 0.54 to 0.78). NIRS ΔStO2 ≥ 20 less in the affected testis had a positive predictive value (PPV) of 100% and sensitivity of 23% to diagnose torsion. Other NIRS ΔStO2 values did not have significant utility to diagnose or rule out torsion. When stratified by Tanner stage, NIRS ΔStO2 in Tanner stage 1-2 patients did not have any utility to diagnose torsion (AUC = 0.53). CONCLUSIONS In pediatric acute scrotum patients, NIRS StO2 readings in testis with torsion were on average lower than the normal testis while readings in testis without torsion were on average slightly higher than the normal testis. However, the use of NIRS to diagnose testis torsion in pediatric patients with acute scrotum had limited utility, it was not able to rule out testis torsion, and a reading was not able to be obtained for both testis in 12%. NIRS had utility when the affected testis had a StO2 ≥ 20 lower than the unaffected, with 100% PPV for torsion but only 23% sensitivity. Although rapid, current NIRS technology as a stand-alone test is not reliable for diagnosing all cases of pediatric testis torsion but further delineating studies and NIRS refinements are warranted. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited bySheth K, Keays M, Grimsby G, Granberg C, Menon V, DaJusta D, Ostrov L, Hill M, Sanchez E, Kuppermann D, Harrison C, Jacobs M, Huang R, Burgu B, Hennes H, Schlomer B and Baker L (2016) Diagnosing Testicular Torsion before Urological Consultation and Imaging: Validation of the TWIST ScoreJournal of Urology, VOL. 195, NO. 6, (1870-1876), Online publication date: 1-Jun-2016. Volume 193Issue 4SApril 2015Page: e463-e464 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Bruce Schlomer More articles by this author Melise Keays More articles by this author Gwen Grimsby More articles by this author Candace Granberg More articles by this author Daniel DaJusta More articles by this author Berk Bergu More articles by this author Lauren Ostrov More articles by this author Kunj Sheth More articles by this author Martinez Hill More articles by this author Emma Sanchez More articles by this author Rong Huang More articles by this author Clanton Harrison More articles by this author Micah Jacobs More articles by this author Helim Hennes More articles by this author Linda Baker More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...