Author's replyBMJ 1996; 312 doi: https://doi.org/10.1136/bmj.312.7042.1359 (Published 25 May 1996) Cite this as: BMJ 1996;312:1359
- Mark Davenport
- Consultant paediatric surgeon Department of Paediatric Surgery, King's Healthcare NHS Trust, King's College Hospital, London SE5 9RS
EDITOR,—The clinical evaluation of the acute scrotum in children is difficult, but I have yet to see a study correctly evaluating the value of radionuclide isotope imaging solely in this population. All of the studies quoted by C J Luscombe and colleagues have been performed predominantly in adults. Children are uncooperative, and their testes are smaller, which must increase the diagnostic error. For instance, in a large series of children with an acute scrotum Lewis et al reported a sensitivity of 95.4% and a specificity of 85.7% for radionuclide imaging,1 which is not as clear cut as Luscombe and colleagues imply. Fenner et al, whom Luscombe and colleagues cite, stated, “We believe its [radionuclide imaging's] routine use in clinical practise is limited” and “would result in needless delays and unjustifiable expense.”2 This is from advocates of the technique.
There is no doubt that delay in surgery results in ischaemia, infarction, and testicular loss. Any diagnostic strategy has to be designed with this as the bottom line. If a nuclear medicine department can perform and report such an investigation within an hour of a request being made by the accident and emergency department, presumably at any time of the day or night, then the investigation may have a role. If the department cannot do this then rapid exploration is the option that is safest (to the testicle). The economic argument is spurious: one false negative scan leading to legal action will wipe out any pecuniary advantage.