BACKGROUND: For patients who present to the Emergency Department (ED) with testicular torsion, reduction of time from diagnosis to detorsion in the operating room (OR) is essential. Testicular salvage rate is improved on intervention within 6 hours of pain duration, and >12 hours has been associated with increased risk of testicular atrophy. Historically at our quaternary children’s hospital, patients with testicular torsion transferred from outside hospitals (OSHs) are first seen in the ED prior to being taken to surgery. The goal of this project was to create a pathway to decrease the time from ED registration to surgery start time for patients transferred to our institution from OSHs with testicular torsion. METHODS: Key stakeholders from urology, nursing, anesthesiology, and the ED collaborated to create a pathway for direct transfer of testicular torsion patients from OSHs to the pre-operative area, bypassing the ED. A defined age group (12 to 18 years old) was identified to mitigate risk of testicular torsion misdiagnosis in pre-pubertal patients. Patients are also required to have an ultrasound-confirmed testicular torsion at the OSH to qualify for ED bypass. This process went live in August 2023.To review the progress of the project, approximately 4 months after implementation the mean time from ED registration to OR start for patients transferred from an OSH in the year prior to pathway initiation was compared with those after pathway initiation using t-tests. Percentage of patients who underwent orchiectomy for non-viable testicle and those with confirmed testicular atrophy on outpatient follow-up were compared with Fischer’s exact test. RESULTS: From 1/2022 to 12/2022, 36 patients were transferred to our facility from an OSH and were seen in the ED prior to surgery for testicular torsion, with a mean time from ED registration to OR start of 69 minutes. Thirteen patients with testicular torsion bypassed the ED from 8/2023 to 11/2023 after pathway initiation. These patients had a significantly shorter mean registration time to OR start time,(20 minutes, p < 0.0001), Figure 1. There was a decrease in orchiectomy (15% vs 28%, p = 0.4737) and atrophy rates (9% vs 15%, 1.0) for patients who bypassed the ED, but this was not statistically significantly different, Table 1. CONCLUSIONS: Over approximately 4 months, time from ED registration to OR start for patients with confirmed testicular torsion transferred from OSH was significantly reduced through an institutional pathway. While there was no significant increase in testicular salvage rate, we hope that this may change with prolonged follow-up and continued pathway refinement.
