Across pediatric hospital emergency departments, the use of diagnostic testing for males with common testicular conditions varies widely, a new report indicates.
The authors, affiliated with Boston Children’s Hospital, suggest that such variation “may lead to increased healthcare costs and disparate outcomes” and conclude that “development of evaluation guidelines for the acute scrotum could decrease variation in testing.” Their report was released online, July 26, by the American Journal of Emergency Medicine.
The study focused on testicular torsion, appendix testis torsion, and epididymitis/orchitis. Diagnostic testing encompassed urinalysis, urine culture, ultrasound, and sexually transmitted infection (STI) testing.
“This study is the first to demonstrate wide variation in the use of urine studies, and even in the use of ultrasound, among children’s hospital emergency departments caring for boys with testicular complaints,” corresponding author Dr. Lois Lee told Reuters Health by email. “Developing a more standard guideline in the evaluation of boys presenting with the acute scrotum may help decrease unnecessary testing (urine studies in boys with testicular torsion) and improve STI testing among teen boys.”
The researchers retrospectively analyzed data from 38 hospitals in a large pediatric healthcare database, covering 17,000 emergency department visits from 2010 through 2015 by males up to age 17 years (median, 11 years) and diagnosed with any of the three testicular conditions.
Rates of testing used for these patients varied widely among hospitals, from 17.0 percent to 84.9 percent for urinanalysis and from 33.1 percent to 100 percent for ultrasound. STI testing was uncommon for all three diagnoses, with an overall rate of just 0.68 percent.
Use of scrotal ultrasound (the gold standard for diagnosing testicular torsion) was common across all diagnoses. During the study period, the only test that showed a substantial change in usage was urine culture, which decreased significantly for all three diagnoses, with an overall decline from 40.6 percent to 31.5 percent.
Similar studies demonstrating this variability of testing on a wide range of clinical topics have been published “multiple, multiple times,” Dr. Al Sacchetti, a spokesperson for the American College of Emergency Physicians and the chief of emergency medicine at Our Lady of Lourdes Medical Center, Camden, New Jersey, told Reuters Health by telephone.
This study, he continued, simply reinforces the fact that “complex diseases are going to have high variability in how physicians manage them.”
Physical exams for the acute scrotum have a lot of variability, Dr. Sacchetti added, making it more difficult to develop diagnostic guidelines and ensure that testicular torsion is never missed. “That’s the one, as an emergency physician, you never want to miss.”