title: Recognise, raise the alarm, react. The process and factors that delay adolescent presentation with testicular pain
Creators: name: MacDonald, Caroline Mary
Publisher: name: University of Glasgow
Year: 2020
Subjects: subject: Testicular health, adolescents, youth, public health, health education, health access

description: Background Adolescent males have high rates of testicular loss after testicular torsion (TT) due to a delay in presentation to hospital after the onset of symptoms. I aim to investigate the issue two-fold: 1. to confirm the scientific basis and ongoing relevance of the need to investigate the phenomena; 2. to investigate the knowledge, views and experiences of young men regarding testicular health to understand the phenomena using qualitative methodology. Methods Meta-analysis following PRISMA guidelines was undertaken with a primary outcome of long-term (&gt;12 months) testicular loss following adolescent TT, in combination with a systematic review investigating predictors of testicular loss. Two regional retrospective audits were undertaken with primary outcomes of immediate testicular loss and time to presentation to hospital after onset of scrotal pain. One-to-one semi-structured interviews were undertaken with young men 11-19 years old with a chaperone, recruited from naturalist environments such as youth clubs. Thematic analysis was undertaken, and data was managed using framework methodology. Recruitment continued until data saturation. Validity was ensured by meticulous study design, high levels of reflexivity and regular supervision. Findings Meta-analysis confirmed a 39% early and 50% long term testicular loss or atrophy rate, with systematic review confirming delay to presentation to predict poor outcomes. Regional audit confirmed ongoing relevancy of the project with early testicular loss of 30% and 50% in Glasgow and Sheffield respectively. Median time from onset of pain to presentation at hospital in Sheffield was 6.25 hours(range 40 minutes to 170 hours) and 24 hours in Glasgow. Qualitative investigation revealed adolescent males are dependent on their parents for all aspects of health, including advice, access and attitudes. The process whereby an adolescent male affects their acute healthcare needs has been revealed. The adolescent recognises there is a problem and raises the alarm by telling their parents. Their parents then synthesise the symptom information and seek help, often after a ‘watch and wait policy’, making an appointment with their general practitioner as the first point of health contact. This process acts as a barrier to young people gaining timely hospital assessment of painful testes. Other factors delaying this process are: poor knowledge of adolescent testicular problems; lack of education and age appropriate information resources; concern from the young people about getting it wrong and raising a false alarm; poor confidence; young peoples’ fear of disrupting the family routine and disincentivisation of hospital attendance confounding concerns about burdening the NHS. Recommendations Recommendations from this study would be to introduce nationalised teaching on testicular health problems in schools, and for parents to receive education of the health conditions whereby a ‘watch and wait’ process is inappropriate and where children and adolescents should be taken directly to hospital.