目的:睾丸扭转(TT)是儿科外科急症,需要及时治疗。这项研究调查了在儿科急诊科(ED)中使用即时超声(POCUS)诊断TT的可行性。
方法:我们回顾了患者的医疗记录,18岁或以下,在2010年1月至2022年10月期间,患者就诊于一所大学附属医院儿科ED,患有急性阴囊疼痛,无外伤史,并接受了诊断性超声检查。
结果:这项研究包括731名患者(中位年龄:9岁),其中,POCUS执行组315例(43%):仅POCUS组188例,和POCUS-and-RADUS组中的127个。其他416例患者(56.9%)为仅RADUS组。总的来说,45例患者(6.2%)被诊断为TT(POCUS执行组19例,仅RADUS组26例)。敏感性,特异性,POCUS诊断TT的阳性和阴性预测值为94.7%,92.9%,46.2%,99.6%,分别。进行POCUS的中位时间短于RADUS(23对61分钟,P<.001)。POCUS执行组的ED住院时间短于仅RADUS组(93对170分钟,P<.001)。在诊断为TT的患者中,首先执行POCUS并没有显著延迟ED过程,包括操作时间(250分钟与205分钟,P=.142)。
结论:对于急性阴囊疼痛患者,儿科急诊医师使用POCUS进行的评估在筛查TT方面表现良好,并可以减少在ED中的停留时间。
OBJECTIVE: Testicular torsion (TT) is a pediatric surgical emergency that requires prompt treatment. This study investigated the feasibility of point-of-care ultrasound (POCUS) for diagnosing TT in the pediatric emergency department (ED).
METHODS: We retrospectively reviewed the medical records of patients, aged 18 years or younger, who visited a university-affiliated hospital pediatric ED with acute scrotal pain without trauma history and underwent diagnostic ultrasounds between January 2010 and October 2022.
RESULTS: This study included 731 patients (median age: 9 years), Of these, 315 (43%) were in the POCUS-performed group: 188 in the POCUS-only group, and 127 in the POCUS-and-RADUS group. The other 416 patients (56.9%) were in the RADUS-only group. In total, 45 patients (6.2%) were diagnosed with TT (19 in the POCUS-performed group and 26 in the RADUS-only group). The sensitivity, specificity, and positive and negative predictive values of POCUS for diagnosing TT were 94.7%, 92.9%, 46.2%, and 99.6%, respectively. The median time to perform POCUS was shorter than RADUS (23 versus 61 minutes, P < .001). The POCUS-performed group had a shorter ED length of stay than the RADUS-only group (93 versus 170 minutes, P < .001). Among the patients diagnosed with TT, performing POCUS first did not significantly delay the ED process, including time to operation (250 versus 205 minutes, P = .142).
CONCLUSIONS: For patients with acute scrotal pain, evaluation performed by pediatric emergency physicians using POCUS performs well in screening TT, and can decrease length of stay in the ED.