{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T05:12:48Z","timestamp":1783660368035,"version":"3.55.0"},"reference-count":25,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T00:00:00Z","timestamp":1782691200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Objectives: Testicular torsion is a time-critical pediatric urological emergency in which delayed presentation may increase the likelihood of orchiectomy. However, preoperative estimation of the immediate intraoperative outcome remains challenging. This study aimed to develop and internally validate machine-learning models integrating ischemic timing variables and complete blood count-derived inflammatory indices to predict orchiectomy versus testicular preservation at index surgical exploration in pediatric and adolescent testicular torsion. Methods: We retrospectively analyzed 165 children and adolescents who underwent surgical exploration for confirmed testicular torsion. The primary endpoint was orchiectomy at index exploration versus testicular preservation through detorsion and\/or orchiopexy. Clinical timing variables and complete blood count-derived indices, including neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, lymphocyte-to-monocyte ratio, white blood cell-to-monocyte ratio, monocyte-to-mean platelet volume ratio, hemoglobin-to-monocyte ratio, systemic inflammatory response index, and aggregate index of systemic inflammation, were evaluated. Five supervised machine-learning algorithms\u2014logistic regression, random forest, XGBoost, LightGBM, and support vector machine\u2014were assessed using nested stratified cross-validation with an outer 5-fold loop and inner 3-fold hyperparameter selection. Model performance was estimated from out-of-fold predictions. Results: Orchiectomy was performed in 37 patients (22.4%), whereas testicular preservation through detorsion and\/or orchiopexy was performed in 128 patients (77.6%). Symptom duration was significantly longer in the orchiectomy group than in the preservation group (48.00 [30.00\u201372.00] vs. 6.00 [2.00\u201324.00] h, p &lt; 0.001). Monocyte count was also higher in the orchiectomy group (0.92 [0.68\u20131.23] vs. 0.65 [0.50\u20130.93] \u00d7 109\/L, p &lt; 0.001). Among the combined models, XGBoost achieved the highest numerical discrimination, with a ROC-AUC of 0.926 \u00b1 0.066 and a bootstrap 95% confidence interval of 0.856\u20130.966. Feature-block and interpretability analyses identified symptom duration as the dominant predictor, followed by emergency department waiting time and selected monocyte-centered inflammatory indices. Conclusions: Immediate intraoperative orchiectomy in pediatric and adolescent testicular torsion was most strongly associated with prolonged symptom duration, while selected complete blood count-derived inflammatory indices provided complementary risk information. The combined XGBoost model showed strong internal discrimination and clinically interpretable predictor patterns. However, the model was internally validated only and requires external validation before clinical implementation.<\/jats:p>","DOI":"10.3390\/diagnostics16132034","type":"journal-article","created":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T15:27:37Z","timestamp":1782746857000},"page":"2034","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Is It Too Late? Machine Learning for Predicting Orchiectomy Versus Testicular Preservation in Acute Torsion"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8714-1874","authenticated-orcid":false,"given":"Onursal","family":"Varlikli","sequence":"first","affiliation":[{"name":"Department of Pediatric Surgery, Faculty of Medicine, Kocaeli University, Umuttepe Yerleskesi, \u0130zmit 41001, Kocaeli, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ozan Can","family":"Tatar","sequence":"additional","affiliation":[{"name":"Department of Information Systems Engineering, Faculty of Technology, Kocaeli University, Umuttepe Yerleskesi, \u0130zmit 41001, Kocaeli, Turkey"},{"name":"Department of General Surgery, Kocaeli City Hospital, \u0130zmit 41050, Kocaeli, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3315-6098","authenticated-orcid":false,"given":"Mustafa Alper","family":"Akay","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, Faculty of Medicine, Kocaeli University, Umuttepe Yerleskesi, \u0130zmit 41001, Kocaeli, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6356-6288","authenticated-orcid":false,"given":"Semih","family":"Metin","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, Faculty of Medicine, Kocaeli University, Umuttepe Yerleskesi, \u0130zmit 41001, Kocaeli, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fahriye Nur","family":"Cuce","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, Faculty of Medicine, Kocaeli University, Umuttepe Yerleskesi, \u0130zmit 41001, Kocaeli, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gulsen","family":"Ekingen Yildiz","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, Faculty of Medicine, Kocaeli University, Umuttepe Yerleskesi, \u0130zmit 41001, Kocaeli, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,29]]},"reference":[{"key":"ref_1","first-page":"835","article-title":"Testicular torsion: Diagnosis, evaluation, and management","volume":"88","author":"Sharp","year":"2013","journal-title":"Am. Fam. Physician"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"184","DOI":"10.1038\/s41443-020-0331-8","article-title":"Testicular torsion: Epidemiological risk factors for orchiectomy in pediatric and adult patients","volume":"33","author":"Greear","year":"2021","journal-title":"Int. J. Impot. Res."},{"key":"ref_3","first-page":"e21790","article-title":"Sonography Findings Predict Testicular Viability in Pediatric Patients With Testicular Torsion","volume":"14","author":"Shields","year":"2022","journal-title":"Cureus"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"821","DOI":"10.1097\/PEC.0000000000001287","article-title":"A Systematic Review of Testicle Survival Time After a Torsion Event","volume":"35","author":"Mellick","year":"2019","journal-title":"Pediatr. Emerg. Care"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2009","DOI":"10.1016\/j.juro.2011.07.024","article-title":"Pediatric testicular torsion epidemiology using a national database: Incidence, risk of orchiectomy and possible measures toward improving the quality of care","volume":"186","author":"Zhao","year":"2011","journal-title":"J. Urol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1016\/j.jpurol.2018.09.017","article-title":"A systematic review and meta-analysis revealing realistic outcomes following paediatric torsion of testes","volume":"14","author":"MacDonald","year":"2018","journal-title":"J. Pediatr. Urol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"99","DOI":"10.5534\/wjmh.180049","article-title":"Neutrophil-Lymphocyte Ratio Predicts Organ Salvage in Testicular Torsion with Marginal Diagnostic Delay","volume":"37","author":"Jang","year":"2019","journal-title":"World J. Men\u2019s Health"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1007\/s00383-025-06124-5","article-title":"Predictors of testicular salvage failure in pediatric testicular torsion: A retrospective analysis of clinical and imaging risk factors","volume":"41","author":"Tian","year":"2025","journal-title":"Pediatr. Surg. Int."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"213","DOI":"10.4103\/2221-6189.291286","article-title":"Evaluation of the neutrophil-lymphocyte ratio, platelet-lymphocyte ratio and monocyte lymphocyte ratio for diagnosis of testicular torsion","volume":"9","author":"Bedel","year":"2020","journal-title":"J. Acute Dis."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"e13357","DOI":"10.1111\/and.13357","article-title":"Can haematologic parameters be used to predict testicular viability in testicular torsion?","volume":"51","author":"He","year":"2019","journal-title":"Andrologia"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"105777","DOI":"10.1016\/j.jpurol.2026.105777","article-title":"Enhancing diagnostic accuracy of pediatric testicular torsion: The role of the neutrophil-to-lymphocyte ratio","volume":"22","author":"Kikkawa","year":"2026","journal-title":"J. Pediatr. Urol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"4","DOI":"10.21037\/tp-2025-aw-741","article-title":"Clinical characteristics of testicular torsion in children and analysis of factors influencing testicular preservation","volume":"15","author":"Yu","year":"2026","journal-title":"Transl. Pediatr."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1481","DOI":"10.1007\/s00383-022-05185-0","article-title":"Testicular salvage: Using machine learning algorithm to develop a predictive model in testicular torsion","volume":"38","author":"Yavuzsan","year":"2022","journal-title":"Pediatr. Surg. Int."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"15154","DOI":"10.1038\/s41598-025-97911-6","article-title":"Development of a nomogram to predict risk factors for orchiectomy after testicular torsion in children","volume":"15","author":"Mao","year":"2025","journal-title":"Sci. Rep."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1007\/s00345-025-05539-y","article-title":"Nomogram predicts risk score and likehood of orchiectomy in patients with testicular torsion: A multicenter retrospective study","volume":"43","author":"Zhang","year":"2025","journal-title":"World J. Urol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"568","DOI":"10.1111\/iju.15420","article-title":"A nomogram for predicting risk factors of testicular salvage after testicular torsion in children","volume":"31","author":"Chen","year":"2024","journal-title":"Int. J. Urol."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Chen, P., Huang, W., Liu, L., Chen, N., Zhou, G., Sun, M., and Li, S. (2022). Predictive value of hematological parameters in testicular salvage: A 12-year retrospective review. Front. Pediatr., 10.","DOI":"10.3389\/fped.2022.989112"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"878","DOI":"10.1159\/000506236","article-title":"Clinical characteristics of testicular torsion and identification of predictors of testicular salvage in children: A retrospective study in a single institution","volume":"104","author":"Feng","year":"2020","journal-title":"Urol. Int."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1016\/j.ajem.2020.11.023","article-title":"Duration of symptoms is the only predictor of testicular salvage following testicular torsion in children: A case-control study","volume":"41","author":"Zvizdic","year":"2021","journal-title":"Am. J. Emerg. Med."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Yu, C., Zhao, J., Lu, J., Wei, Y., Jiang, L., Zhao, T., Lin, T., He, D., Wen, S., and Wu, S. (2021). Demographic, clinical, and socioeconomic factors associated with delayed diagnosis and management of pediatric testicular torsion in West China: A retrospective study of 301 cases in a single tertiary children\u2019s hospital. BMC Pediatr., 21.","DOI":"10.1186\/s12887-021-03001-7"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"22765","DOI":"10.1038\/s41598-023-49820-9","article-title":"Analysis of factors associated with delayed diagnosis and treatment of testicular torsion in 1005 cases from Chongqing city, China: A cross-sectional study","volume":"13","author":"Yi","year":"2023","journal-title":"Sci. Rep."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Kwenda, E.P., Locke, R.A., DeMarco, R.T., and Bayne, C.E. (2021). Impact of hospital transfer on testicular torsion outcomes: A systematic review and meta-analysis. J. Pediatr. Urol., 17.","DOI":"10.1016\/j.jpurol.2021.01.038"},{"key":"ref_23","first-page":"e93512","article-title":"Higher Orchiectomy Rates in Pre-pubescent Testicular Torsion: A Call for Earlier Recognition and Heightened Awareness","volume":"17","author":"Shields","year":"2025","journal-title":"Cureus"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Delgado-Miguel, C., Arredondo-Montero, J., Moreno-Alfonso, J.C., Garavis Montagut, I., San Basilio, M., Hern\u00e1ndez, I., Carrera, N., Mart\u00ednez, L., Iraola, E., and Ruiz Jim\u00e9nez, I. (2025). The role of neutrophil-to-lymphocyte ratio as a predictor of orchiectomy or testicular atrophy after torsion in children: A multicentric study. J. Pers. Med., 15.","DOI":"10.21203\/rs.3.rs-5700353\/v1"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1007\/s00383-025-06282-6","article-title":"Machine learning models in predicting viability after testicular torsion: A proof of concept study","volume":"42","author":"Concio","year":"2026","journal-title":"Pediatr. Surg. Int."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/13\/2034\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T04:13:48Z","timestamp":1783656828000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/13\/2034"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,29]]},"references-count":25,"journal-issue":{"issue":"13","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["diagnostics16132034"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics16132034","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,29]]}}}