Validation of a TWIST Score In Diagnosis of Testicular Torsion – Single-Center Experience

Introduction

The most common causes of acute scrotal pain in children and adolescents include testicular torsion, torsion of the appendix testis, and epididymitis. Testicular torsion is the most dramatic and potentially serious of the acute processes affecting the scrotal contents because it may result in the loss of the testicle. The incidence is estimated to be 1 in 4000 in males younger than 25 years old (Williamson RC. Br J Surg 1976; 63(6): 465–476.). Approximately 65 percent of cases occur in boys between the ages of 12 and 18 years (Edelsberg JS et al., Emerg Med Clin North Am. 1988; 6(3): 521–546.). In a prospective study (Barbosa JA et al., J Urol. 2013; 189(5): 1859–1864.) of 338 children with an acute scrotum evaluated at a single institution, the following clinical scoring system for testicular torsion was derived: nausea or vomiting – 1 point, testicular swelling - 2 points, hard testis on palpation – 2 points, high riding testis – 1 point, absent cremasteric reflex – 1 point. A score ≥5 diagnosed testicular torsion with a sensitivity of 76%, specificity of 100%, and a positive predictive value of 100% (prevalence 15%). A score ≤2 excluded testicular torsion with a sensitivity of 100%, a specificity of 82%, and a negative predictive value of 100%. This study support the practice of early surgical consultation for children in whom testicular torsion is strongly suspected based upon history and physical examination rather than performing imaging.