Purpose This audit was performed to assess the true torsion rate and rate of testicular salvage in children undergoing emergency scrotal exploration in Western Australia. Additionally, we examined the outcomes in children transferred from other hospitals, including use of ultrasound and testicular salvage with the aim of improving outcomes in children with testicular torsion. Methodology Retrospective chart audit from 2018-2022 of all emergency scrotal explorations performed at Perth Children’s Hospital. Results 1368 scrotal explorations were performed over the five-year period. The rate of acute testicular torsion was 14% (193) and 57% (110) were left sided. The overall testicular salvage rate was 88%. 27% (53) of patients with acute testicular torsion were transferred from another hospital. Nearly half (49%, 26) of these children underwent ultrasound prior to discussion with paediatric surgery. The testicular salvage rate in this group was significantly lower than the salvage rate in the non-transferred children (74% versus 93%, p=0.0003). Conclusion There are multiple factors that may contribute to significantly lower testicular salvage rate in children transferred from peripheral hospitals with testicular torsion. However, numerous areas for improvement were identified in this study including: avoiding unnecessary ultrasound and empowering peripheral and regional hospitals with adult surgical services to perform emergency scrotal explorations.