Screening and diagnosis

Classification and risk stratification

Perioperative care

Quality improvement

Patient education

Nonpharmacologic interventions

Therapeutic procedures

Respiratory support

Follow-up and surveillance

Specific circumstances

Preventative measures

Medical management

Surgical interventions

Inpatient care

Diagnostic procedures

Diagnostic investigations

Insufficient evidence to make a recommendation.

Strongly favor this test or intervention.

The Testicular Workup for Ischaemia and Suspected Torsion (TWIST) score is a clinical calculator used in the evaluation of acute scrotal pain in males, particularly in pediatric and adolescent populations. The TWIST score aids in the differentiation between testicular torsion, a urological emergency, and other less severe causes of scrotal pain such as epididymitis or orchitis. 

The TWIST score is based on three clinical parameters: testicular swelling, hard testis, and absent cremasteric reflex. Each parameter is assigned a certain number of points, and the total score ranges from 0 to 7. A higher score indicates a higher likelihood of testicular torsion.

The TWIST score is not applicable in patients with a clear alternative diagnosis for scrotal pain, such as trauma or hernia. It should also not be used in patients with chronic or recurrent scrotal pain, as it is designed for the evaluation of acute symptoms.

Testicular Workup for Ischaemia and Suspected Torsion score (TWIST score)

# Description:
The Testicular Workup for Ischaemia and Suspected Torsion (TWIST) score is a clinical calculator used in the evaluation of acute scrotal pain in males, particularly in pediatric and adolescent populations. The TWIST score aids in the differentiation between testicular torsion, a urological emergency, and other less severe causes of scrotal pain such as epididymitis or orchitis. 

The TWIST score is based on three clinical parameters: testicular swelling, hard testis, and absent cremasteric reflex. Each parameter is assigned a certain number of points, and the total score ranges from 0 to 7. A higher score indicates a higher likelihood of testicular torsion.

The TWIST score is not applicable in patients with a clear alternative diagnosis for scrotal pain, such as trauma or hernia. It should also not be used in patients with chronic or recurrent scrotal pain, as it is designed for the evaluation of acute symptoms.
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# Inputs:
A. Testicular swelling (+2)
B. Hard testes (+2)
C. Absent cremasteric reflex (+1)
D. Nausea or vomiting (+1)
E. High-riding testis (+1)
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# Scoring:
- If score >= 5, then High risk: 100% positive predictive value for torsion. Prompt urological consultation and surgery required.
- If score >= 3, then Intermediate risk. Ultrasound required.
- If score <= 2, then Low risk: 100% negative predictive value for torsion. Ultrasound generally not required.
- If score == 0, then Please make a selection)

Testicular torsion

Guidelines

Key sources

Diagnostic investigations

Medical management

Surgical interventions