Monroe Carell Jr. Children's Hospital at Vanderbilt University Medical Center
Introduction: Testicular torsion is a surgical emergency that is managed either with detorsion and orchidopexy if the testicle is salvageable, or orchiectomy if the testicle is unsalvageable. Significant efforts have been made to decrease the time from arrival at the hospital to diagnosis and definitive operative management. However, the most significant time delay occurs prior to arrival at the hospital.
Methods: We developed a survey intended to gauge awareness of testicular torsion among boys, parents and school nurses, and to understand how each group would manage scrotal pain. The survey was distributed to parents via ResearchMatch, and to school nurses through a statewide department of education. After completing the survey, participants viewed a 5-minute animated video that we developed about testicular torsion and answered several follow-up questions.
Results: 643 parents of boys completed the survey. Most parents (58.5%) report they would call their pediatrician if their son complained of acute scrotal pain, though only 21.8% report they would go straight to the emergency room. 126 (19.7%) of respondents report they would wait to see if the pain would go away, and of these parents, 40% report they would wait longer than 3 hours. Only 55.7% of parents have heard of testicular torsion. After viewing the video, only 15/624 participants (2.4%) report that they would wait to see if acute onset scrotal pain resolved. 376 school nurses completed the survey. 102/376 (27%) have seen a patient with acute scrotal pain in the school environment. Prior to viewing the educational video, only 43% of nurses said they would recommend a caregiver take the child directly to the emergency room, while this increased to 85% after watching the video. Twenty boys ages 10-18 participated in the survey, and 80% of them reported that if they suddenly developed testicular pain at school they would not tell a teacher or nurse. 75% of boys reported they would wait at least 4 hours before telling an adult about their pain regardless of whether they were at home or at school.
Conclusions: Half of parents have never heard of testicular torsion, and many parents report that if their child developed acute scrotal pain, they would wait for it to go away before considering calling a physician or going to the emergency room. Without education about testicular torsion, boys are unlikely to immediately tell an adult about acute testicular pain, at school or at home. Viewing a short, animated, educational video was found to be beneficial to parents, boys and school nurses. We hypothesize that further education of parents, nurses and boys themselves will lead to more immediate interaction with the healthcare system when boys develop testicular pain.