{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,4]],"date-time":"2025-10-04T12:26:33Z","timestamp":1759580793891,"version":"3.40.5"},"reference-count":28,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2021,8,10]],"date-time":"2021-08-10T00:00:00Z","timestamp":1628553600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Paediatrics Child Health"],"published-print":{"date-parts":[[2022,1]]},"abstract":"<jats:sec><jats:title>Aim<\/jats:title><jats:p>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\u2010course from first symptom to \u2018knife to skin\u2019 in these conditions, to determine where delays occur and facilitate a systems approach to better manage these children.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>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\u2010course of events from admission to surgery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>(i) Scrotal exploration: the median time from onset of symptoms to presentation was 12\u2009h (interquartile range (IQR): 5\u201348\u2009h). In children over 5\u2009years 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\u2009h (IQR: 4\u201324\u2009h). The median cumulative in\u2010hospital time was over 6\u2009h (368\u2009min, IQR: 247\u2013634\u2009min).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Time to presentation contributes significantly to testicular ischaemic time. This delay to timely surgical intervention is multi\u2010factorial, 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\u2010requisite level of surgical expertise required.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jpc.15684","type":"journal-article","created":{"date-parts":[[2021,8,10]],"date-time":"2021-08-10T20:15:16Z","timestamp":1628626516000},"page":"146-151","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Access to emergency paediatric surgery for testicular torsion or intestinal volvulus in New Zealand: A system perspective"],"prefix":"10.1111","volume":"58","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5044-5935","authenticated-orcid":false,"given":"Cameron","family":"Castle","sequence":"first","affiliation":[{"name":"Department of Paediatric Surgery, Child Health Service Wellington Regional Hospital  Wellington New Zealand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Spencer W","family":"Beasley","sequence":"additional","affiliation":[{"name":"Department of Paediatric Surgery Christchurch Hospital  Christchurch New Zealand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1837-9966","authenticated-orcid":false,"given":"Kiarash","family":"Taghavi","sequence":"additional","affiliation":[{"name":"Department of Paediatric Surgery, Child Health Service Wellington Regional Hospital  Wellington New Zealand"},{"name":"Department of Paediatrics University of Melbourne  Melbourne Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2021,8,10]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1464-410x.2000.00106.x"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.sempedsurg.2006.10.008"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.juro.2011.07.024"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1651-2227.2012.02644.x"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.5811\/westjem.2014.11.22495"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpurol.2018.09.017"},{"key":"e_1_2_6_8_1","first-page":"588","volume-title":"Newborn Surgery","author":"Zani A","year":"2017"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpedsurg.2014.01.039"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1152\/ajpgi.90595.2008"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejrad.2006.03.013"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/0022-3468(92)90293-G"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clnu.2014.04.015"},{"key":"e_1_2_6_14_1","unstructured":"Royal Australasian College of SurgeonsAcute Scrotal Pain and Suspected Testicular Torsion Guidelines. Melbourne Australia; 2018. Available from:https:\/\/www.surgeons.org\/en\/about\u2010racs\/position\u2010papers\/acute\u2010scrotal\u2010pain\u2010and\u2010suspected\u2010testicular\u2010torsion\u2010guidelines\u20102018[accessed February 2021]."},{"key":"e_1_2_6_15_1","unstructured":"Royal College of SurgeonsCommissioning Guide: Management of Paediatric Torsion. Sponsoring Organisations: British Association of Paediatric Surgeons British Association of Paediatric Urologists. London UK; 2016. 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