Take a child to the hospital right away for sudden, worsening severe pain; don't make him hold out until school ends
- Top value
- Evidence A
- Buys life
- For: Child aged 3–18
- Free
- Takes minutes
- No willpower
In plain words
Some illnesses are counted in hours. If a boy has sudden severe pain on one side of the scrotum, it is testicular torsion: the blood vessel attached to the testicle has twisted shut and cut off its blood supply. If it is treated within 6 hours, 97.2% of testicles are saved. By 19 to 24 hours, only 42.5% are. This kind of pain can't wait until school lets out or until exams are over.
- Cost
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Free. Take half a day off and take the child to the emergency department.
- What you get
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Researchers searched systematically, found 30 case-report series covering 2116 patients with testicular torsion, and pooled them. Of these, 1283 cases were reported in 6-hour bands. Counted from the start of the pain, the share of testicles saved was 97.2% at 0 to 6 hours, 79.3% at 7 to 12 hours, 61.3% at 13 to 18 hours, 42.5% at 19 to 24 hours, 24.4% at 25 to 48 hours, and 7.4% after 48 hours. In larger blocks, it was 90.4% within 12 hours, 54.0% at 13 to 24 hours, and 18.1% after 24 hours. The authors concluded that the window in which a testicle can be saved may be longer than the 6 to 8 hours usually quoted. So even if the pain has already lasted a long time, still get it treated, and don't skip it on the thought that it is too late anyway.
- Notes
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Tell boys ahead of time: if there is ever sudden severe pain down there, say so right away, and don't be embarrassed. Testicular torsion is most common in boys going through puberty, and many of them grit their teeth and say nothing because it is hard to bring up. Other conditions that are also counted in hours include acute appendicitis (which can perforate if left too long), diabetic ketoacidosis and meningitis. This section did not check, one by one, how much worse each of these gets for every few hours of delay. What they share as a warning sign is this: it comes on suddenly, keeps getting worse, and is unlike any earlier episode. For how to recognize an emergency and how to call for a vehicle, see §13.
- Evidence grade
- A : Specific numbers from meta-analyses, large cohorts or randomized trials; for law and policy, the statute or official text.
- Sources
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- Mellick LB, et al. (2019). A Systematic Review of Testicle Survival Time After a Torsion Event. Pediatric Emergency Care. https://doi.org/10.1097/PEC.0000000000001287
Translated from the Chinese original. Original book, section 30, tip 1. Content may be out of date and rules differ by place. When you actually deal with an agency, a doctor or a court, follow what local officials, doctors and lawyers tell you. Disclaimer