Author, date and country | Patient group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
---|---|---|---|---|---|
Rabinowitz R 1984 USA | A consecutive case series evaluated 245 boys, newborn to 18 years of age, with acute scrotal swelling. | Case series. | None of the 125 subjects who had an intact cremasteric reflex had ipsilateral testicuiar torsion. The cremasteric reflex was absent in all 56 subjects with testicular torsion. | An absent cremasteric reflex in boys with acute scrotal swelling had a sensitivity of 100% (95% confidence interval (Cl], 91%-100%), a specificity of 66% (95% CI, 59%-72%), and a likelihood ratio of a negative test (presence of a cremasteric reflex) of 0.01 {95% CI, 0.001-0.21). | The study did not include patients older than 18 years. |
Kadish H A et al 1988 USA | A retrospective review of patients with the diagnosis of epididymitis, testicular torsion, or torsion of appendix testis. Ninety patients were included in the study (64 with epididymitis, 13 with testicular torsion, and 13 with torsion of appendix testis). | Retrospective. | All 13 patients with testicular torsion had a tender testis with an absent cremasteric reflex. | Patients presenting with a tender testicle and an absent cremasteric reflex were more likely to have a testicular torsion rather than epididymitis or torsion of appendix testis. | Retrospective study. Limited number of cases. |
Fewer patients with epididymitis had a tender testicle (69%) or an absent cremasteric reflex (14%). | An absent cremasteric reflex was the most sensitive physical finding for diagnosing testicular torsion. | ||||
Hughes ME et al 2001 USA | A case of preserved cremasteric reflex in association with testicular torsion. | Case study | Original studies reported a 100% correlation between the presence of a cremasteric reflex with nontorsion of the testis. Conversely, the absence of a cremasteric reflex raises suspicion of, but is not reliable in the diagnosis of torsion. | This case represents the first reported instance in the emergency medicine literature of a normal cremasteric reflex in association with acute testicular torsion. | Case report |
Nelson CP et al 2003 USA | A patient with preserved cremasteric reflex and a surgically confirmed testicular torsion. | Case study | The authors report a case of surgically confirmed testicular torsion in which the cremasteric reflex clearly was present at presentation. | Case report | |
Elliot M. Paul et al 2004 USA | 358 boys presenting with acute scrotal pain and/or swelling between 1/1999–10/2002 (ages: 0–18 years) were evaluated. | Retrospective | Results were compared with final diagnoses as established from operative findings, office charts, and/or telephone contact. 211 charts were available for complete analysis. The presence of cremasteric reflex (CR) on the symptomatic side correlated with the absence of testicular torsion in 167 cases. The absence of CR correlated with surgically confirmed testicular torsion in 15 cases. | There were 27 cases of absent CR in non-torsed testes and two cases of present CR in surgically confirmed torsion. | Retrospective study. Not all patients charts were available for the study. |
Yang, C et al 2011 China | A retrospective review of patients with a diagnosis of testicular torsion between January 1990 and January 2010 was performed. We included 118 cases in the study, accounting for 9.01% of all cases of acute scrotum. | Retrospective | Absence of cremasteric reflex presented in 112 (94.9%) patients. | Two of the other six patients with normal cremasteric reflex had testicular torsion and had their testes removed. | Retrospective study |