Search

Case Presentation: A 44-year-old Black male presented to the emergency department with left scrotal pain. His initial workup did not identify an etiology of his symptoms; however, he returned the following day with worsening pain and a radiology-performed ultrasound then revealed a segmental testicular infarct.Discussion: Segmental testicular infarcts are a rare, often idiopathic, source of scrotal pain. Diagnosis is made by ultrasound, and repeat imaging may be required if not apparent on initial evaluation. Management is typically conservative although some require surgical intervention.

Case Presentation: A 44-year-old Black male presented to the emergency department with left scrotal pain. His initial workup did not identify an etiology of his symptoms; however, he returned the following day with worsening pain and a radiology-performed ultrasound then revealed a segmental testicular infarct.Discussion: Segmental testicular infarcts are a rare, often idiopathic, source of scrotal pain. Diagnosis is made by ultrasound, and repeat imaging may be required if not apparent on initial evaluation. Management is typically conservative although some require surgical intervention.

Aim Overseas studies have suggested a bias in emergency department patient selection between paediatric and emergency medicine trainees. This study aimed to detect whether a similar bias existed in an Australasian setting. Specifically, we sought to determine whether vocational trainees choose patients based on presenting complaint, triage category or patient age. Methods A retrospective review of patients attending the Monash Medical Centre Paediatric Emergency Department (PED) was conducted during four consecutive registrar rotations from July 2010 to March 2011. A 2-week period during the middle of each term was chosen, and data were collected from times when both emergency and paediatric registrars were present in the department. Results A total of 1222 patient records were reviewed. Emergency registrars saw 278 patients, and paediatric registrars saw 413 patients. Of those seen by emergency registrars, 62.9% had medical diagnoses, and 37.1% had non-medical diagnoses; 14.4% were triaged as high acuity, and 85.6% were low acuity. Of those seen by paediatric registrars, 70% had medical diagnoses, and 30% had non-medical diagnoses, while 15.9% were high acuity, and 84.1% were low acuity. Emergency registrars saw 2.5% neonates, 6.5% adolescents. Paediatric registrars saw 3.6% neonates and 6.1% adolescents. There was no significant difference between paediatric and emergency registrars in selecting patients. Conclusions Bias does not appear to exist in the selection of patients in this Australasian PED. Further study should address the impact of unbiased patient selection on emergency department efficiency and trainee education.Copyright © 2014 The Authors. Journal of Paediatrics and Child Health © 2014 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

Aim Overseas studies have suggested a bias in emergency department patient selection between paediatric and emergency medicine trainees. This study aimed to detect whether a similar bias existed in an Australasian setting. Specifically, we sought to determine whether vocational trainees choose patients based on presenting complaint, triage category or patient age. Methods A retrospective review of patients attending the Monash Medical Centre Paediatric Emergency Department (PED) was conducted during four consecutive registrar rotations from July 2010 to March 2011. A 2-week period during the middle of each term was chosen, and data were collected from times when both emergency and paediatric registrars were present in the department. Results A total of 1222 patient records were reviewed. Emergency registrars saw 278 patients, and paediatric registrars saw 413 patients. Of those seen by emergency registrars, 62.9% had medical diagnoses, and 37.1% had non-medical diagnoses; 14.4% were triaged as high acuity, and 85.6% were low acuity. Of those seen by paediatric registrars, 70% had medical diagnoses, and 30% had non-medical diagnoses, while 15.9% were high acuity, and 84.1% were low acuity. Emergency registrars saw 2.5% neonates, 6.5% adolescents. Paediatric registrars saw 3.6% neonates and 6.1% adolescents. There was no significant difference between paediatric and emergency registrars in selecting patients. Conclusions Bias does not appear to exist in the selection of patients in this Australasian PED. Further study should address the impact of unbiased patient selection on emergency department efficiency and trainee education.Copyright © 2014 The Authors. Journal of Paediatrics and Child Health © 2014 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

Introduction: It is accepted that scrotal exploration should be undertaken if testicular torsion is suspected. We set out to assess the incidence of torsion in patients undergoing scrotal exploration, and whether pre-operative ultrasound influenced the decision to operate. Method(s): We conducted a 3-year audit of emergency scrotal explorations for acute scrotal pain at the Monash Hospital network, (undertaken by paediatric surgery, urology and general surgery). Patient and hospital/surgical team demographics were collected, as well as information about duration of pain, time to proceeding to surgery, incidence of torsion, orchidopexy (uni/bilateral) and orchidectomy. We also assessed the numbers of patient who received preoperative ultrasound, the ultrasound results, and whether this correlated to clinical findings at the time of surgery. Result(s): There were 290 scrotal explorations, 106 confirmed torsions and 15 orchidectomies. Age range of presentation was 2 days to 56 years (mean 13.9). Duration of pain prior to presentation was 15 minutes to 5 weeks (mean 31 hours). Time from presentation to commencement of surgery was 39-2880 minutes (mean 203 minutes). Highest incidence of exploration occurred in 12-15 year olds. 45 patients underwent preoperative ultrasound; 25 suggested definitive torsion. Of these, 22 were confirmed at operation. Of remaining ultrasounds, most suggested alternative pathology but stated 'torsion cannot be excluded', and 3 suggested intermittent torsion. Of those equivocal reports, 1 of 18 patients was torted at operation. (Table Presented) Conclusion(s): Torsion was more common in adolescents as expected. Ultrasound may be useful in select cases of scrotal pain where there is low clinical suspicion of torsion, but does not replace clinical judgement, and should not delay prompt surgical exploration in suspected torsion.

Introduction: It is accepted that scrotal exploration should be undertaken if testicular torsion is suspected. We set out to assess the incidence of torsion in patients undergoing scrotal exploration, and whether pre-operative ultrasound influenced the decision to operate. Method(s): We conducted a 3-year audit of emergency scrotal explorations for acute scrotal pain at the Monash Hospital network, (undertaken by paediatric surgery, urology and general surgery). Patient and hospital/surgical team demographics were collected, as well as information about duration of pain, time to proceeding to surgery, incidence of torsion, orchidopexy (uni/bilateral) and orchidectomy. We also assessed the numbers of patient who received preoperative ultrasound, the ultrasound results, and whether this correlated to clinical findings at the time of surgery. Result(s): There were 290 scrotal explorations, 106 confirmed torsions and 15 orchidectomies. Age range of presentation was 2 days to 56 years (mean 13.9). Duration of pain prior to presentation was 15 minutes to 5 weeks (mean 31 hours). Time from presentation to commencement of surgery was 39-2880 minutes (mean 203 minutes). Highest incidence of exploration occurred in 12-15 year olds. 45 patients underwent preoperative ultrasound; 25 suggested definitive torsion. Of these, 22 were confirmed at operation. Of remaining ultrasounds, most suggested alternative pathology but stated 'torsion cannot be excluded', and 3 suggested intermittent torsion. Of those equivocal reports, 1 of 18 patients was torted at operation. (Table Presented) Conclusion(s): Torsion was more common in adolescents as expected. Ultrasound may be useful in select cases of scrotal pain where there is low clinical suspicion of torsion, but does not replace clinical judgement, and should not delay prompt surgical exploration in suspected torsion.