Evaluation of TWIST Score in Predicting Testicular Torsion in Children

Background: Torsion of the testis is a surgical emergency because the likelihood of testicular salvage decreases as the duration of the torsion increases. TWIST (Testicular Workup for Ischemia and Suspected Torsion) score had been validated for diagnosis of testicular torsion in children with acute scrotum. Objective: establish the validity and applicability of using TWIST score in the diagnosis of testicular torsion in children. Methods: The study includes 53 patients presented with acute scrotum, TWIST score obtained for all patients and classifies the patients into 3 groups of testicular torsion: Low risk (1-2), Intermediate risk: (3-4) and high risk (5-7). Results: TWIST Score analysis shows that the low-risk score patients are (8, 15.1%), the intermediate risk score patients are (21, 39.6%) and high-risk score patients are (24, 45.3%). Torsion group have significantly high-risk score compared to the non-torsion group. There was a high level of agreement between initial and final diagnosis, but there are 6 patients with false positives among the high-risk patients with no false negative patients among the low and intermediate risk patients. The parameters that show high accuracy in testicular torsion diagnosis are: Hard testis (100.0% vs 11.4%), absent cremasteric reflux (83.3% vs 28.6%), nausea/vomiting (77.8% vs 45.7%) and high riding testis (61.1% vs 20.0% ).