ESPU Congress 2018 - Abstract Book

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.