Factors affecting pediatric patient transfer in testicular torsion

Background: Testicular torsion is a surgical emergency, and interhospital transfer could delay care and increase the risk of orchiectomy. This study identifies factors associated with transfer for pediatric testicular torsion. Methods: This retrospective cross-sectional study examined emergency department (ED) visits for testicular torsion by men aged 1-21 y in National Emergency Department Sample from 2006 to 2012. Freestanding children's hospitals were excluded. Analyses were weighted to produce nationally representative estimates. Patient- and institutional-level predictors of transfer were evaluated using Rao-Scott chi-square tests and multivariable logistic regression. Results: There were 11,435 ED visits for testicular torsion resulting in admission or transfer. In multivariable regression, the probability of transfer decreased with increasing age but remained higher for patients aged 15-17 y than for those aged 18-21 y (odds ratio [OR] = 1.51, P < 0.001) and was lower for patients living in zip codes in the highest income quartile (OR = 0.69 versus lowest, P = 0.003) or with listed comorbidities (OR = 0.55, P < 0.001). Transfer was less likely in the Northeast (OR = 0.28 versus Midwest, P < 0.001), at urban hospitals (OR = 0.31, P < 0.001), teaching institutions (OR = 0.55, P < 0.001), and level I or II trauma centers (OR = 0.31, P < 0.001). Transfer was less common with increasing annual pediatric ED volume (OR = 0.95 per 1000 patients, P < 0.001). Transfer rates increased significantly over the study period (23.6%-38.8%, P < 0.001). Conclusions: Older adolescents with testicular torsion are more likely to be transferred than young adults. Interhospital transfers in these patients may represent a potential target for improving care. Future work should focus on evaluating the effect of transfer on the risk for undergoing orchiectomy.