Title : Improving scrotal examination in male patients presenting with acute abdominal pain: An audit and quality improvement intervention
Abstract:
Background: NICE guidance states that all male patients presenting with abdominal pain should undergo a scrotal examination. This is based on evidence that testicular torsion may present atypically and that abdominal pain alone can be the only symptom in a significant proportion of cases. Failure to assess the scrotum risks delayed diagnosis and potential testicular loss.
Aim: To determine whether surgical on-call junior doctors consistently enquire about testicular pain and perform scrotal examinations in male patients presenting with acute abdominal pain, and to evaluate the impact of a targeted intervention.
Methods: Male patients admitted with abdominal pain between 1st July and 31st October 2024 were identified from surgical handover lists. Clinical documentation was reviewed to assess whether enquiry about testicular pain and scrotal examination had been carried out. Following the initial audit, a reminder poster was displayed prominently in the emergency department to prompt clinicians to examine the scrotum in all male patients presenting with abdominal pain. A follow up audit cycle was then completed 6 months later using the same criteria to measure improvement.
Results: The initial audit included 102 male patients with a median age of 40 years. Only one patient had documented enquiry about testicular pain and only twenty patients had a recorded scrotal examination. After the introduction of the emergency department reminder poster, documentation improved significantly. Enquiry about testicular pain increased to 58% and scrotal examination was recorded in 62% of cases. Improvement was seen across all age groups, with the greatest increase among patients aged 30 years and younger.
Conclusions: Compliance with NICE recommendations for scrotal assessment in male patients presenting with abdominal pain was initially very low. A simple visual reminder intervention in the emergency department led to a substantial improvement in both enquiry about testicular pain and performance of scrotal examination. This demonstrates that low cost, targeted interventions can effectively improve adherence to clinical standards. Continued reinforcement through education and routine documentation prompts may further sustain and enhance compliance.
