Karmazyn et al used a clinical score and ultrasonography to evaluate boys with acute scrotum. This can help determine the appropriate diagnostic approach. The authors are from Schneider Children's Medical Center and Tel Aviv University in Israel.
Patient selection: pediatric male with acute scrotum
Parameters:
(1) duration of pain
(2) cremasteric reflex
(3) testicular tenderness
Parameter
Finding
Points
duration of pain
> 6 hours
0
<= 6 hours
1
cremasteric reflex
normal
0
absent or decreased
1
testicular tenderness
none or focal
0
diffuse
1
total score =
= SUM(points for all 3 parameters)
Interpretation:
• minimum score: 0
• maximum score: 3
• The higher the score the higher the probability for testicular torsion.
Score
Recommendation
0
consider an alternative diagnosis
1 or 2
perform scrotal ultrasound
3
perform testicular exploration
Features to look for on ultrasound - one or both of the following:
(1) absent or decreased testicular blood flow (sensitivity 63%)
(2) coiled spermatic cord
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