Evaluation of testicular workup for ischemia and suspected torsion score in patients presenting with acute scrotum

Abstract

Background:Testicular torsion is one of the causes of acute scrotum and it requires timely evaluation and surgical treatment. Color Doppler is considered investigation of choice, but it may delay treatment, as, many times, it may not be available for emergency situations. Barbosa et al. created Testicular Workup for Ischemia and Suspected Torsion (TWIST) score based on clinical parameters for clinical diagnosis of testicular torsion. We have evaluated this score in our population.Materials and Methods:We retrospectively calculated TWIST score in patients of acute scrotum admitted to tertiary teaching institute. Patients without complete TWIST score were excluded from the study. The scoring system consisted of testicular swelling (2 points), hard testicle (2), absent cremasteric reflex (1), nausea/vomiting (1), and high-riding testis (1). Statistical analysis was done to evaluate the validity of scores.Results:A total of 118 patients were included in the study, out of which 45 (38%) patients had testicular torsion. The mean age of patients was 16.6 years in testicular torsion patients and 15.2 years in other patients. Cutoff for low-risk and high-risk patients was two and five, respectively. Fifty percent, 26.2%, and 23.8% of patients were present in low-, intermediate-, and high-risk groups. Negative predictive value of TWIST score for low-risk patients was 96.61% while positive predictive value for high-risk patients was 92.86%.Conclusions:TWIST score has high predictive value and can be used for clinical diagnosis of testicular torsion. It can decrease the need of color Doppler in about 50% of cases and can prevent delay in treatment.

Presentation delay, misdiagnosis, inter-hospital transfer times and surgical outcomes in testicular torsion: analysis of statewide case series from central Brazil

“…Difficulties with the differential diagnosis of acute testicular disease could be addressed by the dissemination of a predictive tool such as the Testicular Workup for Ischemia and Suspected Torsion (TWIST) score ( 22 , 23 ), which attributes points to medical history and physical examination findings (testicular swelling=2, hardened testicle=2, cremasteric reflex absent=1, nausea/vomiting=1 and high-riding testis=1), with scores ≤2 representing low risk, 3-4 intermediate and >4 high risk for testicular torsion. Patients with high scores should be promptly operated, those with low scores should be followed, and further investigation would only be warranted for patients with intermediate scores ( 24 ). Furthermore, the score has high positive and negative predictive values even when used by non-physicians ( 25 ).…”

Atypical symptoms of testicular torsion in a 7-year-old child: A case report

“…Testicular Workup for Ischemia and Suspected Torsion (TWIST) score is a useful tool for testicular torsion diagnosis since it encompasses testicular swell-ing, hard testis, nausea/vomiting, absent cremasteric reflex, and high riding testis, which encompasses common signs of testicular torsion. [ 24 ] Meta-analyses revealed the TWIST score achieves a high sensitivity (0.984) and high specificity (0.975). [ 25 ] However, TWIST does not capture erythema or abdominal pain, highlighting that this case is atypical at first.…”

Diagnostics of testicular torsion using the TWIST scale (Testicular Workup for Ischemia and Suspected Torsion)

“…Исследования опубликованы с 2013 по 2022 годы. Проведён анализ 2274 пациентов в возрасте от 1 месяца до 21 года [5, 12, 15, 17 -23, 25] и 101 пациента от 19 до 42 лет [16,24]. У 422 выявлен ПЯ, что составило 17,7% случаев.…”

“…У 422 выявлен ПЯ, что составило 17,7% случаев. Оценку симптомов проводили специалисты экстренного приёма [5,19,22], урологи [15,23], хирурги [24], детские хирурги [20,25], врачи общей практики [17], в остальных статьях не указано [12,16,18,21].…”