Experiences and perceptions of acute testicular pain, with a focus on reasons for delayed presentation to hospital: a qualitative evidence synthesis

Anderson, Elizabeth; Chaplin, Wendy J; Turner, Chloe; Johnson, Graham D; Blake, Holly; Tabner, Andrew

Abstract

Background
The annual incidence of testicular torsion is approximately 1 in 4000 males under the age of 25. Despite the 97% testicular salvage rate when surgical intervention is within 6 hours of onset, orchidectomy is required in 40% of cases. These comparatively poor outcomes are driven by delays to intervention, the majority of which take place prior to presentation to healthcare. This study synthesises existing evidence to understand factors leading to delayed presentation to hospital in individuals with acute scrotal pain.
Methods
A comprehensive literature search was performed with support from an information scientist. Two authors performed article screening, data extraction, and inductive thematic synthesis independently, with disagreements resolved by discussion at each stage. An assessment of confidence in the review findings was performed using the ConQual approach.
Results
The search identified 1251 unique articles for screening, with 5 eligible for inclusion; all included publications were drawn from 2 PhD projects. Synthesis of these articles revealed 5 descriptive themes with 5 sub-themes. A lack of knowledge and education about testicular health, embarrassment, and reliance on others for access to healthcare are major factors leading to delays in presentation. Societal and cultural impacts on health-seeking behaviour and denial were also causes of delayed presentation to healthcare.
Discussion
A lack of knowledge about testicular anatomy and health among both adults and children is amenable to improvement through education, and would likely impact many of the factors identified as contributory to delays. Communication was an overarching factor connecting the descriptive themes.

Citation

Anderson, E., Chaplin, W. J., Turner, C., Johnson, G. D., Blake, H., & Tabner, A. (2024). Experiences and perceptions of acute testicular pain, with a focus on reasons for delayed presentation to hospital: a qualitative evidence synthesis. Emergency Medicine Journal, Article emermed-2024-214125. https://doi.org/10.1136/emermed-2024-214125

• Journal Article Type: Review
• Acceptance Date: Oct 19, 2024
• Online Publication Date: Nov 7, 2024
• Publication Date: Nov 7, 2024
• Deposit Date: Oct 21, 2024
• Publicly Available Date: Nov 7, 2024
• Journal: Emergency Medicine Journal
• Print ISSN: 1472-0205
• Electronic ISSN: 1472-0213
• Publisher: BMJ Publishing Group
• Peer Reviewed: Peer Reviewed
• Article Number: emermed-2024-214125
• DOI: https://doi.org/10.1136/emermed-2024-214125
• Keywords: Testicular torsion; delay; time; qualitative; review
• Public URL: https://nottingham-repository.worktribe.com/output/40855898