Twist and Shout: Review of care provided to children and young people with testicular torsion
The National Confidential Enquiry into Patient Outcome and Death (NCEPOD) has published Twist and Shout, a review of the pathway and quality of care provided to children and young people aged 2-24 years who presented to hospital with testicular torsion, from the Child Health Clinical Outcome Review Programme. The sampling period of 1st April 2021 to 31st March 2022 was used and data were included from 574 clinician questionnaires, 143 organisational questionnaires and the assessment of 635 sets of case notes.
This report contains a number of key findings, including those in relation to delays in care. Testicular torsion is a surgical emergency requiring prompt diagnosis and surgical intervention to preserve the testicle. Delay in presenting to hospital has been consistently shown to lead to poor outcomes. Also, after admission to hospital for suspected testicular torsion, operative delay adversely affects the chance of salvaging the testicle. In a systematic review of 1,283 patients, when surgical intervention occurred within a six-hour window from the onset of testicular pain, there was a 97% chance of the patient’s testicle being saved. While the study concluded that survival percentages are significant, beyond the widely accepted time period of six-eight hours, the salvage rates decreased, the longer that surgical intervention was delayed.
The report also includes recommendations that highlight areas that are suitable for regular local clinical audit and quality improvement initiatives by those providing care to this group of patients. It calls for the results of such work to be presented at quality or governance meetings, and for action plans to improve care to be shared with executive boards.
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