A 6 year old boy presents on a Saturday afternoon to A&E; at a remote DGH (which has A&E; facilities and inpatient Paediatrics, but no out-of-hours / emergency operating). He has a painful, swollen hemi-scrotum and a presumed diagnosis of testicular torsion is made. The local surgeon and anaesthetist are willing to undertake the procedure. The nearest hospital with emergency surgical provision is 40 minutes away, and their CEPOD list is busy. What should happen to this child? Should he be transferred or treated locally?
All agreed that this child should be an obvious priority for scrotal exploration, and all efforts should be made to expedite this.
A 40 minute transfer time in reality takes far longer than this to organise, and there would be further delays for assessment at the receiving hospital, even if the theatre happened to be waiting.
The procedure requires no special equipment above that which could be found in a district general hospital, so the key decision has to be whether the teams available have the required skills to provide safe care.
If a theatre team can be made available, consideration must also be given to the care of the child in the post-op period, both in recovery, and the ward.
It could be argued that the greatest chance of saving a torted testis would be from immediate operation in the original hospital, and if overnight post-op care is not available, the child may have to be transferred to the second centre once out of the immediate post-op recovery phase. However, in the absence of a complete team able to look after the child safely, the panel felt it would have to remain a defensible option to transfer the child to the second hospital for surgery.
