Twist and Shout - Testicular Torsion

NCEPOD Report Twist and Shout
A review of the pathway and quality of care provided to children and young people presenting to hospital with testicular torsion

NCEPOD release Twist & Shout - Testicular torsion. 

Read the executive summary & full report on the NCEPOD 2024 Testicular Torsion Pages


Key Messages

  • Raise public awareness about testicular torsion
    • Steps in maternity/antenatal care (e.g. advice for care of a new baby in the red book) and post-natal care should be taken to educate parents/carers about the pathology and early warning signs of testicular torsion. The need to urgently attend an emergency department, and not ‘wait and watch’, to achieve surgical intervention (if necessary) within six hours when testicular pain is experienced is a critical component of this education. The health curriculum from nursery through to higher education needs to involve advice about testicular torsion.
  • Training to recognise testicular torsion in primary and emergency care
    • Training modules require updating to enable primary care and emergency staff to recognise atypical signs of testicular torsion and the need to enact urgent referral pathways for timely surgical intervention.
  • Reduce in-hospital delays through clear, documented pathways of care and transfer
    • Transfers should be minimised where intervention can be performed on-site. Where transfers are unavoidable, patients must be transferred to a centre where scrotal explorations can be performed safely on-site with a pre-alert system in place to inform the receiving hospital of an incoming transfer. Transfers must also be classed as urgent with the aid of clear and documented protocols and pathways. Auditing of the testicular torsion pathway, at least annually, is essential to identify areas for improvement.
  • Senior assessment and investigations
    • Patients with suspected testicular torsion should have an urgent referral and clinical review by a senior surgical decision-maker (minimum ST3 or equivalent) specialising in urology, paediatric surgery, or general surgery. A consensus must also be made on the use of Doppler ultrasound on patients with suspected testicular torsion.