Back to 2026 Abstracts
The Express Lane: Implementation of a Direct to OR Transfer Protocol for Acute Testicular Torsion
Julia Beth Finkelstein, MD, MPH, Erin Casey, RN, BSN, MBA, David Johnson, MS.
Boston Children's hospital, Boston, MA, USA.
BACKGROUND: Timely surgical intervention is critical for testicular salvage in acute testicular torsion (ATT). Because regional centers frequently lack pediatric specialty care, affected children require transfer to tertiary hospitals, inherently delaying definitive management. We evaluated the efficacy of a standardized Direct to Operating Room (DtOR) protocol designed to expedite surgical intervention.
METHODS: We performed a retrospective review of pediatric patients transferred to our tertiary care center with a scrotal ultrasound confirmed diagnosis of ATT from an outside facility between November 2023 and May 2026. The DtOR protocol fast-tracked incoming transfer patients directly to the OR, bypassing our institutional Emergency Department and eliminating routine repeat sonography. Tracked metrics included patient age, facility arrival time, OR arrival time, and time of surgical incision. Neonatal torsion cases were excluded from the current analysis. The primary outcome measure was the time interval from institutional arrival to surgical incision (in minutes). This metric was compared to a pre-protocol cohort of transfer patients for the 18 months preceding DtOR protocol implementation.
RESULTS: The pre-protocol cohort comprised 61 patients, and the post-protocol cohort included 47 patients with a median age of 14 years old (range: 18 months-17 years). Implementation of the DtOR protocol resulted in a statistically significant reduction in arrival-to-incision time, decreasing from a pre-protocol median of 91 minutes (IQR: 23-220) to a post-protocol median of 33 minutes (IQR: 26-44, p<0.001). The DtOR protocol eliminated redundant diagnostic imaging, diminishing repeat scrotal ultrasound rates from 41% (25/61) in the pre-protocol transfer cohort to zero post-protocol. No false-positive clinical diagnoses or negative operative explorations occurred in the post-protocol group.
CONCLUSIONS: Implementing a standardized DtOR protocol for pediatric ATT transfers is safe, highly efficient, and eliminates redundant imaging when appropriate. This multidisciplinary care pathway substantially minimizes institutional delays, optimizing the time-sensitive window for testicular salvage.
Back to 2026 Abstracts
