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 calculator evaluates the likelihood of testicular torsion based on user responses to five specific clinical signs or symptoms. Each of these inputs is associated with a predefined point value.

The calculator takes the following inputs:

- Testicular swelling: 2 points if true
- Hard testes: 2 points if true
- Absent cremasteric reflex: 1 point if true
- Nausea or vomiting: 1 point if true
- High-riding testis: 1 point if true

Each response might be a boolean value (true or false). For every true input, the respective points are added to calculate the total TWIST score, which ranges from 0 to a maximum of 7 points.

The interpretation of the TWIST score is provided based on the cumulative sum as follows:

1. **High risk (score ≥ 5):** A score of 5 or more indicates a high risk with a 100% positive predictive value for testicular torsion. It suggests that prompt urological consultation and likely surgery are required.
2. **Intermediate risk (score 3-4):** A score between 3 and 4 signifies an intermediate risk, necessitating an ultrasound for further evaluation.
3. **Low risk (score ≤ 2):** A score of 2 or less reflects a low risk with a 100% negative predictive value for testicular torsion, typically meaning that an ultrasound is not generally required.

The Testicular Workup for Ischaemia and Suspected Torsion score (TWIST score) is a clinical tool designed for the evaluation of acute scrotal pain, specifically to differentiate testicular torsion from other causes. The target patient population includes individuals presenting with acute scrotal pain, where timely diagnosis is crucial to prevent testicular loss.

The primary components of the TWIST score include five clinical findings: testicular swelling, hard testes, absent cremasteric reflex, nausea or vomiting, and high-riding testis. Each of these components contributes to the overall score, which guides the subsequent management strategy.

Testicular torsion

Guidelines

Key sources

Diagnostic investigations

Medical management

Surgical interventions