Testicular Workup for Ischemia and Suspected Torsion in Pediatric Patients and Resource Utilization

Roberts, Chris; Ricks, William A.; Roy, John D.; Hartin, Charles W.; Alemayehu, Hanna

doi:10.1016/j.jss.2020.08.008

Cited by 7 publications

(8 citation statements)

References 18 publications

(32 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…17 The remaining 13 articles met the inclusion criteria and were included in the final analysis. 8,9,18–28…”

Section: Resultsmentioning

confidence: 99%

“…Ten studies were restricted to boys, 8,9,19–23,26–28 1 study focused on males >16 years 18 and 2 studies included males of any age group. 24,25 TWIST was administered by physicians including urologists, 8,28 general surgeons, 18 pediatric surgeons, 22,26 emergency physicians 20,27 and surgical residents. 23,25 One study measured its utility among emergency medical technicians.…”

Section: Resultsmentioning

confidence: 99%

“…MADTA of prospective and retrospective studies excluding nonphysician examiners and adult patients was performed, consisting of 9 studies. 8,19–21,23,26–28 The summary ROC AUC was 0.912 (0.867, 0.942). A TWIST score of 1 corresponded to a sensitivity of 0.981 and a specificity of 0.241, while a score of 7 corresponded to a sensitivity of 0.204 and specificity of 0.996.…”

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Diagnosing with a TWIST: Systematic Review and Meta-Analysis of a Testicular Torsion Risk Score

Qin

2022

Journal of Urology

View full text Add to dashboard Cite

Purpose:The Testicular Workup for Ischemia and Suspected Torsion (TWIST) score is a 7-point tool to evaluate acute scrotal pain. Parameters include testicular swelling (2 points), hard testis (2), high-riding testis (1), absent cremasteric reflex (1) and nausea/vomiting (1). This review aimed to determine the diagnostic utility of TWIST and its role in risk stratification.Materials and Methods:A systematic review and meta-analysis of diagnostic test accuracy was conducted. Five risk stratification systems were explored, including the Barbosa (0–2, 3–4, 5–7) and Sheth (0, 1–5, 6–7) scoring systems, to obtain sensitivity, specificity and area under the receiver operating curve.Results:Thirteen studies were identified, 9 prospective studies proceeded to meta-analysis of diagnostic test accuracy and 5 pediatric studies (1,060 patients, 199 torsions) were included in the primary analysis. The most accurate risk stratification system was Barbosa (0–2, 3–4, 5–7), with an AUC of 0.924 (95% CI: 0.865, 0.956). Barbosa showed favorable sensitivity in low-risk patients (0.984), facilitating rule out of torsion, and favorable specificity (0.975) in high-risk patients, facilitating urgent surgical exploration. Sensitivity and specificity in intermediate-risk patients were 0.922 and 0.682, respectively, indicating a need for further workup with ultrasound. Using this stratification, 65.2% of patients were low-risk, 19.9% were intermediate-risk and 14.9% were high-risk. Per 100 presentations of acute scrotum, there was a missed torsion rate of 1.6/100, ultrasound rate of 19.9/100 and negative exploration rate of 2.5/100.Conclusions:TWIST is an effective tool for suspected testicular torsion and is appropriate for widespread adoption. The Barbosa scoring system is reliable and reduces reliance on scrotal ultrasound.

show abstract

“…17 The remaining 13 articles met the inclusion criteria and were included in the final analysis. 8,9,18–28…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Diagnosing with a TWIST: Systematic Review and Meta-Analysis of a Testicular Torsion Risk Score

Qin

2022

Journal of Urology

View full text Add to dashboard Cite

show abstract

“…Ceux-ci peuvent contribuer à l’errance diagnostique initiale, notamment chez l’enfant ou l’adolescent, et lorsqu’elle est présentée au premier plan, elle peut masquer dans presque 20 % des cas l’existence d’une torsion [ 29 ]. Pour cette population pédiatrique, certains auteurs ont pu récemment proposer un « score de risque » permettant de classer, d’après des éléments cliniques, le tableau clinique comme étant à risque faible, intermédiaire ou élevé de correspondre à une torsion testiculaire, qui peut aider à aiguiller vers ce diagnostic [ 24 ].…”

Section: Prise En Chargeunclassified

Prise en charge de la torsion du testicule par un chirurgien généraliste isolé en Afrique

Long-Depaquit

Chiron

Bourgouin

et al. 2022

Mtsi

View full text Add to dashboard Cite

Résumé L’apparition d’une douleur scrotale brutale et intense pose plusieurs problèmes quand elle survient chez un homme jeune en Afrique. Parmi les étiologies possibles, la torsion testiculaire est l’urgence chirurgicale à écarter, car au-delà de 6 heures d’évolution le pronostic fonctionnel du testicule est engagé. L’évolution septique vers une fonte purulente, en cas de torsion dépassée, est aussi possible. D’incidence légèrement inférieure à celle des pays occidentaux, la méconnaissance de cette pathologie par les acteurs de santé de proximité, la précarité ou l’isolement sanitaire de certaines populations dans certaines régions sous-médicalisées, contribuent aux retards diagnostique et thérapeutique. Cela conduit souvent à une évolution péjorative, la perte du testicule étant directement corrélée au délai de prise en charge. La torsion testiculaire a ainsi été identifiée comme l’une des principales causes d’infertilité masculine en Afrique. Pourtant, le diagnostic clinique et le traitement chirurgical nécessitent peu de moyens et restent accessibles dans un milieu à faibles ressources ou en conditions précaires. Cet article reprend le tableau clinique de torsion du cordon spermatique et la technique d’orchidopexie.

show abstract

“…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].…”

Section: Introductionunclassified

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

et al. 2023

View full text Add to dashboard Cite

Introduction. Testicular torsion (TT) is the most common pediatric emergency urological pathology. To reduce the duration of the diagnostic stage, systems for assessing the risks of testicular torsion based on anamnesis and clinical symptoms were proposed. In 2013, Barbosa et al. proposed the TWIST system (testicular examination for ischemia and suspected torsion), which became the most well-known and widespread. This system makes it possible to identify groups of patients who do not require scrotal ultrasound, which reduces the number of stages in the diagnosis of TT.Objective. To evaluate the experience of using and diagnostic significance of the TWIST scale based on available data in scientific publications.Materials & methods. Review and analysis of literature data on the use of the TWIST scale.Results. We conducted an analysis of 13 publications, in which the results of using TWIST with statistical analysis were published. In all articles, the final diagnosis was established according to Doppler scrotal ultrasound or intraoperatively. Analysis of publications shows that even in large foreign medical centers there is a problem of emergency scrotal ultrasound, which increases the time of testicular ischemia with ТТ. To use the TWIST scale, only history and physical examination data are needed. Any specialist can use the scale in his practise. The low probability of TT in the low-risk group makes it possible not to perform routine scrotal revision, and, consequently, material and human resources are saved.Conclusion. Literature analysis has shown that the use of the original TWIST scale proposed by J.A. Barbosa, in case of suspected testicular torsion, has sufficient diagnostic accuracy, high sensitivity and specificity of TT detection, which significantly reduces the need for ultrasound, reduces the diagnostic time before surgery, that increases testicular survival.

show abstract

Testicular Workup for Ischemia and Suspected Torsion in Pediatric Patients and Resource Utilization

Cited by 7 publications

References 18 publications

Diagnosing with a TWIST: Systematic Review and Meta-Analysis of a Testicular Torsion Risk Score

Diagnosing with a TWIST: Systematic Review and Meta-Analysis of a Testicular Torsion Risk Score

Prise en charge de la torsion du testicule par un chirurgien généraliste isolé en Afrique

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

Contact Info

Product

Resources

About