455 - Testicular Point-of-Care Ultrasound Utilization for Pediatric Patients

Sunday, April 30, 2023

3:30 PM – 6:00 PM ET

Poster Number: 455
Publication Number: 455.312

Paul A. Khalil, Nicklaus Children’s Hospital, Miami, FL, United States; Ee Tay, Hassenfeld Children's Hospital at NYU Langone, New York, NY, United States; Antonio Riera, Yale University, Westport, CT, United States; Adam Sivitz, Rutgers New Jersey Medical School, Livingston, NJ, United States; Samuel Lam, Children's Hospital Colorado, Aurora, CO, United States

Presenting Author(s)

Paul A. Khalil, MD (he/him/his)

Attending Physician
Nicklaus Children’s Hospital
Miami, Florida, United States

Background: Acute scrotal pain is a common presentation to the Pediatric Emergency Department (ED), and its evaluation may require emergent ultrasound studies for time-sensitive diagnoses. Testicular Point-of-Care Ultrasound (POCUS) studies performed in the ED may assist in expediting diagnosis and management. Access to POCUS or Radiology Ultrasound (RADUS) for acute scrotal pain may vary by institutions.

Objective: This study aims to describe the utilization of ultrasound and access to surgical management for pediatric patients who present with acute scrotal pain in the Pediatric ED.

Design/Methods: A survey inquiring on hospital settings, institutional types, availability of POCUS, RADUS, and surgical management for scrotal pathology and testicular torsion was open to members of the Brown Pediatric Emergency Medicine Listserv and P2Network from 12/14/2021-03/16/2022. Pediatric EM POCUS program directors of institutions with POCUS availability and who responded to the first survey were sent a second survey to further evaluate POCUS and RADUS use for testicular torsion management at their institutions.

Results:
The initial survey had 314 respondents from 147 separate institutions. Most respondents worked in an urban, academic, pediatric ED setting (Table 1). 14% of the respondents will perform POCUS prior to RADUS for testicular torsion but if the study was negative for findings, 84% will still order a RADUS study for further evaluation. For those institutions with surgical management capability, only 3% of the surgeons will operate on testicular torsion based on positive POCUS findings.
19 PEM POCUS program directors completed the second survey (Table 2). Majority of the testicular ultrasounds are performed by Radiology sonographers with estimated result turnaround times between 60-90 minutes.

Conclusion(s): Performance of testicular ultrasound by POCUS remains low despite how time-sensitive it is to diagnose testicular torsion. Opportunities to encourage POCUS use for scrotal pathology may expedite management when compared to RADUS. Further study is needed to inquire on behavior and barriers preventing more POCUS studies to be performed in the Pediatric ED.