Emergency Department Clinical Pathway for Children with
Acute Non-traumatic Scrotal/Testicular Pain
Transfer from Outside Hospital
- Upload Imaging to Ambra — sent to CHOP Radiology
- Instructions to Upload Imaging
Child with Non-traumatic
Acute Scrotal/Testicular Pain
Acute Scrotal/Testicular Pain
-
Presence of any of the following:
- Acute onset
- Moderate, severe pain
- Nausea, vomiting
- Reported swelling
PEM Attending Examines Child
- For High Probability Testicular Torsion:
- Order US Scrotum Hi Prob with Doppler
- Notify Urology
ED Team Assessment
- History and Physical
- Review Differential Diagnosis
- Consider analgesia, IVF, NPO, POC UA
Non-high Probability Testicular Torsion
- Normal lie of testicle
- Cremasteric reflex present
- Mild pain
- No nausea /vomiting
- No abdominal pain (Pre-pubertal child)
High Probability Testicular Torsion
- Abnormal lie of testicle
- High riding, horizontal
- Absent cremasteric reflex
- Moderate to severe pain
- Nausea, vomiting
- Abdominal pain (Peri- or Post-pubertal child)
Testicular, Scrotal exam normal
Pain resolved
Review Differential Diagnosis
Pain resolved
Review Differential Diagnosis
Consider US Scrotum w/Doppler,
POC UA, STI Testing
POC UA, STI Testing
PE Findings consistent with
alternative diagnosis
(low probability testicular torsion)
alternative diagnosis
(low probability testicular torsion)
Urgent US Scrotum w/Doppler
Notify Urology of Child with High
Probability of Testicular Torsion
Probability of Testicular Torsion
- Order US Scrotum Hi Prob with Doppler
- Notify US Technologist
- Keep child NPO
Ultrasound Results
US Negative
Review Alternative Diagnoses
Review Alternative Diagnoses
US consistent with
Alternative Diagnoses
Alternative Diagnoses
US Positive for
Testicular Torsion
Testicular Torsion
Alternative Diagnoses
Consult Considerations
*Hydroceles typically cause nontender scrotal swelling
- Torsion of Appendix Testis
- Orchitis/Epididymitis
- Tumor
- Incarcerated Inguinal Hernia
- Intermittent Testicular Torsion
- Varicocele
- Vasculitis
- Orchalgia
- Hydrocele*
- Surgeon notifies OR
- IV, NS bolus as indicated
- Pain control