100
29
th
CONGRESS OF THE ESPU
S12: GENITALIA 2
Moderators: Nicolas Kalfa (France), TBA
ESPU Meeting on Thursday 12, April 2018, 16:34–17:14
16:34–16:37
S12-1 (PP)
DEVELOPMENT OF A NOVEL SCORING SYSTEM FOR
DIAGNOSIS OF TESTICULAR TORSION "CLINICAL
& RADIOGRAPHIC EXPLORATION OF SUSPECTED
TORSION" (CREST)
Tariq Osman ABBAS
1
, Mansour ALI
2
and Abdelrahman ELKADHI
2
1) Hamad General Hospital, Pediatric Surgery, Doha, QATAR - 2) Hamad Medical Corporation, Pediatric Surgery
Department, Doha, QATAR
PURPOSE
We introduce a novel scoring for diagnosing testicular Torsion in children; The Clinical &Radiographic
Exploration of Suspected Torsion (CREST) which uses urological history, physical examination and
Doppler ultrasound findings to assess risk of Testicular torsion preoperatively. Parameters include:
sudden pain (2 points), testis swelling (1 points), vomiting (1 point), heterogenous testis (3 points),
hydrocele (1 point) and absent vascularity (2 points). We assessed the usefulness of the CREST
score when determined by pediatric surgeons mirroring emergency room evaluation of acute scrotal
pain.
MATERIAL AND METHODS
Children following surgical scrotal exploration for acute scrotum over the study period were retro-
spectively enrolled in this study. After retrieving basic history, physical examination findings, two
independent pediatric radiologists blinded to the intra-operative findings reevaluated the imaging
of all patients in order to calculate CREST score. All data were captured into REDCap™ and ROC
curves were used to evaluate the diagnostic usefulness of CREST.
RESULTS
Of 65 patients (mean age 10.3 years) 44 (13.0 years) had torsion. CREST score cutoff values
of 0 and 10 derived from ROC analysis identified 21 high, 37 intermediate and 7 low risk cases
(positive predictive value 97.5 %, negative predictive value 99 %).
CONCLUSIONS
CREST score assessed by pediatric surgeons and radiologists is accurate. Low risk patients do
not require surgical exploration. High risk patients can proceed to surgery, with > 50 % avoiding
negative exploration. Surgical personnel may be able to calculate CREST score to guide immediate
surgical intervention and help reducing morbidity and costs of negative surgical explorations.