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Performance analysis of US showed a sensitivity of 100% and a specificity of 98.8%. There was no significant difference between wait times of operated and non-operated patients. Time to US (p 0.0001, r = 0.96) and time to OT (p 0.0001, r = 0.64) correlated significantly with the total time from presentation to surgery. There has been an improvement in the diagnostic performance of scrotal US for testicular torsion over the past 18 years. Quality improvement programmes targeted at reducing wait times for patients presenting with