Faster care for pediatric testicular torsion

A new multicenter study published in the Journal of Pediatric Urology used data from the National Surgical Quality Improvement Program Pediatric (NSQIPP) Testicular Torsion Collaborative across 29 hospitals. It examined which care processes help children with testicular torsion receive faster diagnosis and treatment. The study, co-authored by Hans Pohl, MD, chief of Urology at Children’s National Hospital, included 1,007 patients and focused on identifying system-level practices that could reduce delays in diagnosis for this time-sensitive emergency.

What’s been the holdup in the field?

Progress in testicular torsion care has been slow for several reasons. The condition is rare but serious, making it hard for single hospitals to study outcomes in large numbers. Care is also spread across emergency medicine, radiology, surgery and urology, which can lead to delays driven by system issues rather than clinical decisions. There has been no widely used, standardized care pathway, such as routine Testicular Workup for Ischemia and Suspected Torsion (TWIST) scoring or clear imaging rules. Until recently, the field lacked a national system to collect time-based data and link it to changeable care processes. The NSQIPP Testicular Torsion Collaborative now helps close these gaps.

How will this work benefit patients?

Faster diagnosis means a better chance to save the testicle. Standardized pathways reduce delays, uncertainty and variation in care. Over time, this can lead to fewer unnecessary orchiectomies and better physical and emotional outcomes for children, regardless of where care begins.

How does this work move the field forward?

Hospitals using standardized evaluation protocols and the TWIST score reached ultrasound significantly faster. Free-standing children’s hospitals and American College of Surgeons (ACS) Children’s Surgery–verified institutions also showed better timeliness. Nearly half of patients were transferred from another facility. The overall orchiectomy rate was 15.8% and did not differ by hospital type or care process. These findings suggest that specific protocols and hospital structures can meaningfully speed diagnosis, even when removal rates are similar.

Beyond these results, this study shifts torsion care toward data-driven improvement. By using national process measures, it identifies practical steps — like standardized pathways and TWIST scoring — that speed diagnosis and provide clear benchmarks for hospitals. The NSQIP Testicular Torsion Collaborative also creates a lasting framework to test, share, and scale improvements across institutions.

What did you find that excites you?

“What stood out to me most was how quickly children’s hospitals and ACS-verified centers were able to move once the patient arrived, even when that child was transferred from another facility. It shows how much system readiness and clear pathways matter in an emergency like testicular torsion,” said Dr. Pohl.

Read the study, Leveraging NSQIPP testicular torsion process measures: Initial survey of the NSQIPP testicular torsion collaborative, in the Journal of Pediatric Urology.

Additional authors from Children’s National include: Shane Battie, Tonya D. Davis and Jacqueline Saito, MD.