[size=20px]You are called by a physician at a local urgent care facility about a 12-year-old boy with 8 hours of right scrotal pain. A scrotal ultrasound shows twisting of the right spermatic cord and there is an absence of testicular blood flow on color doppler. The most appropriate plan is to

 

a transfer the patient directly to the operating room at your hospital.

 

b transfer the patient to your hospital’s emergency department for assessment.

 

c ask the urgent care physician to send you the ultrasound images to review with a pediatric radiologist.

 

d ask the urgent care physician to attempt manual detorsion.[/size]

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Correct answer

a transfer the patient directly to the operating room at your hospital.

 

The treatment priority with testicular torsion is expedient operative detorsion. A 2024 APSA TEC Talk pointed out that delays in definitive care are mostly due to pre-hospital delays due to deficits in patient and primary caregiver education and knowledge. Direct transfer from a referring facility to the operating room provides an opportunity for expeditious intervention, but the logistics of this practice may be difficult. Manual detorsion attempts are unlikely to be successful and may delay definitive treatment. The ultrasound findings are diagnostic and do not require confirmation. While transfer to your emergency department may be necessary, it is not the optimal plan as it may result in added delay.