Access to emergency paediatric surgery for testicular torsion or intestinal volvulus in New Zealand: A system perspective.
intestinal malrotation
intestinal volvulus
paediatric emergencies
paediatric surgery
testicular torsion
Journal
Journal of paediatrics and child health
ISSN: 1440-1754
Titre abrégé: J Paediatr Child Health
Pays: Australia
ID NLM: 9005421
Informations de publication
Date de publication:
Jan 2022
Jan 2022
Historique:
revised:
26
07
2021
received:
08
06
2021
accepted:
27
07
2021
pubmed:
11
8
2021
medline:
27
1
2022
entrez:
10
8
2021
Statut:
ppublish
Résumé
The risk of organ loss is increased in children with testicular torsion or intestinal volvulus if surgical management is not expedient. The current retrospective study aims to review the time-course from first symptom to 'knife to skin' in these conditions, to determine where delays occur and facilitate a systems approach to better manage these children. One hundred consecutive paediatric cases of scrotal exploration for presumed testicular torsion, and 100 neonatal cases presenting with possible malrotation/volvulus were analysed to evaluate the exact time-course of events from admission to surgery. (i) Scrotal exploration: the median time from onset of symptoms to presentation was 12 h (interquartile range (IQR): 5-48 h). In children over 5 years of age, 36% (33/93) were transferred from an external district service area. (ii) Malrotation/volvulus: the median duration of symptoms prior to arrival/assessment was 12 h (IQR: 4-24 h). The median cumulative in-hospital time was over 6 h (368 min, IQR: 247-634 min). Time to presentation contributes significantly to testicular ischaemic time. This delay to timely surgical intervention is multi-factorial, and must be addressed at a public health level. Support and training in the management of testicular torsion should be provided to all adult surgeons/trainees that may care for these children. In general, this condition is best managed at the presenting hospital whenever appropriate expertise is available. Novel pathways that streamline care may improve efficiency at an institutional level. Addressing issues of access to specialised neonatal surgery is more vexed on account of the tyranny of distance, and the pre-requisite level of surgical expertise required.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
146-151Informations de copyright
© 2021 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).
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