The Role of NLR, PLR, and hematologic parameters in the differential diagnosis of pediatric acute scrotum

Aim: The primary causes of acute scrotum are testicular torsion (TT) and epididymo-orchitis (EO), and the rapid and accurate differential diagnosis of these two conditions is crucial for preserving testicular function.The objective of this research is to assess the clinical value of the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and hematological parameters in the differential diagnosis of TT and EO in pediatric patients.Materials and Methods: Ninety-nine children who presented with scrotal pain and were diagnosed with either TT or EO in the pediatric emergency department of Aksaray University Training and Research Hospital between January 1, 2019, and May 25, 2025, were included in the study.Results: In the comparison of the groups, NLR and neutrophil counts were found to be meaningfully higher in children with TT (p = 0.002).For the prediction of TT, the cut-off value for NLR was determined as >3.53 with a sensitivity of 52.5% and specificity of 78% (AUC: 0.684 [0.580-0.788]),and for neutrophil count, the cut-off was >8915/mm with a sensitivity of 30.0% and specificity of 88.1% (AUC: 0.681 [0.577-0.785]).Discussion: NLR and neutrophil count may serve as useful markers in distinguishing TT from EO, particularly in pediatric patients where physical examination and imaging findings are inconclusive.