ESPE Abstracts (2016) 86 P-P1-753

The Intra- and Inter-User Reliability of Testicular Volume Estimation - A Simulation Study

Shamani De Silvaa, Ladan Akbarian-Tefaghia, Joseph Langleyb, Andrew Stantonb, Neil P Wrightc & Charlotte J Eldera,c

aUniversity of Sheffield, Sheffield, UK; bSheffield Hallam University, Sheffield, UK; cSheffield Children’s Foundation NHS Trust, Sheffield, UK

Background: Measuring testicular volume (TV) by orchidometer is a standard method of pubertal staging in boys. A paucity of evidence exists as to its inter and intra-user reliability and the impact of clinicians’ gender, training and experience on the accuracy of measurements.

Objective and hypotheses: We engineered prosthetic models of different size testes to investigate the reliability of TV estimation.

Method: The study was conducted over the three-day British Society Paediatric Endocrinology and Diabetes (BSPED) meeting, November 2015. Three child-sized mannequins displayed latex scrotum containing prosthetic testicles of 3, 4, 5, 10 and 20 ml. Demographic data, paediatric endocrinology experience, TV examination training, information on examination technique and TV estimations were collected anonymously. Delegates were asked to repeat their measurements later during the meeting. Scrotum order was changed daily to minimise recall bias.

Results: 208 delegates participated (158F, 50M): 50% consultants, 30% trainees, 9% clinical nurse specialists, 11% other. Ninety delegates performed repeat measurements. 25.5% had received formal training in TV estimation. There was variability in examination technique, the majority preferring the patient recumbent and using both look and feel for estimation. Delegates measured TV accurately on 30% of occasions. Overestimations were made on 30% of measurements and underestimation on 40%. Males and females were similarly inaccurate, males estimating correctly on 31.4% of occasions and females on 29.7%. Experience improved accuracy with consultants scoring accurately 31.7%, paediatric trainees 28.4%, nurse specialists 27.2% and newly qualified doctors 11.1% of the time. Inaccuracies were highest at the smallest volumes: 57% overestimating 3 ml testis, compared with 17% for the 20 ml testis. This is clinically pertinent considering the different management decisions made at smaller volumes.

Conclusion: Overall TV estimation accuracy was poor. There was considerable variation between subjects and at lower volumes. Seniority improves measurement estimation. Delegate feedback supported more training and developing these models for teaching simulation.

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