Efficacy of TWIST (Testicular Workup for Ischemia and Suspected Torsion) Score System for Differential Diagnosis in Acute Scrotum
Keywords:acute scrotum, diagnostic, testicular torsion
The acute scrotum is a common urological emergency and has a broad differential diagnosis. The TWIST (Testicular Workup for Ischemia and Suspected Torsion) Score, a risk scoring system based on signs and symptoms, can be invaluable in managing patients with the acute scrotum, specifically testicular torsion. This study aimed to evaluate the effectiveness of the TWIST scoring system for differential diagnosis of acute scrotal population. The study was conducted using secondary data, medical records from 111 male patients diagnosed with acute scrotum inÂ Saiful Anwar General Hospital Malang between January 2015 and December 2018. Data about the onset of pain, first contact, history, physical examination findings, any adjunct test performed, and intra-operative findings were collected. The efficacy of the TWIST score in diagnosing testicular torsion was determined by calculating the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Of the 111 patients, 43 patients (38.7%) had testicular torsion. The mean age wasÂ 17.49 (6.69) years. A total of 39 patients were classified as high risk as per the TWIST Score with cut point 5 had 83.7% sensitivity, 95.6% specificity, 92.3% positive predictive value (PPV), and 90.3% negative predictive value (NPV). The area under the curve was 0.82. A low testicular salvage rate of 18% was obtained. The use of the TWIST Score in clinical practice can accurately determine high-risk patients who can proceed straight to the operating theatre without the need for an ultrasound, while low-risk patients can be treated without ultrasound examination.Â
Jefferies MT, Gupta A, Proctor A. The management of acute testicular pain in children and adolescents. BMJ Urol. 2015
Lee SM, et al. Nationwide Epidemiological Study of Testicular Torsion. J Korean Med Sci. 2014 Jul.29:1684-7.
Srinivasan A, Cinman N, Feber KM, Gitlin J, Palmer LS. History and physical examination findings predictive of testicular torsion: an attempt to promote clinical diagnosis by house staff. J Pediatr Urol. 2011;7(4):470â€“474.
Ta A, D'Arcy FT, Hoag N, Lawrentschuk N. Testicular torsion and the acute scrotum: current emergency management. Eur J Emerg Med. 2016 Jun;23(3):160-5.
Zhao LC, Lautz TB, Meeks JJ, Maizels M. Pediatric testicular torsion epidemiology using a national database: incidence, risk of orchiectomy and possible measures toward improving the quality of care. J Urol. 2011 Nov;186(5):2009-13
TekgÃ¼l S, Dogan HS, Kocvara R, et al. 2017. EAU Guidelines on Paediatric Urology. Nâ€™Dow J, Bjartell A, et al (eds.), European Association of Urology Guidelines 2017 Ed. Europe: EAU. 20-1
Barbosa JA, Tiseo BC, Barayan GA, et al. Development and Initial Validation of a Scoring System to Diagnose Testicular Torsion in Children. J Urol. 2013.189:1859-64.
Kunj RS, Melise K, Gwen MG, Candace F, Vani SM. Diagnosing Testicular Torsion before Urological Consultation and Imaging: Validation of the TWIST Score. Journal of Urology. June 2016. 195, 1870-1876, June 2016
Frohlich LC, Paydar-Darian N, Cilento BG, et al. Prospective Validation of Clinical Score for Males Presenting With an Acute Scrotum. Acad Emerg Med 2017;24:1474â€“82.
Moosaje SH. A Validation Of The â€œTWISTâ€ Score In Diagnosis Of Acute Testicular Torsion In The Acute Scrotum In Kenyatta National Hospital. 2017
Shah MI, Chantal Caviness A, Mendez DR. Prospective pilot derivation of a decision tool for children at low risk for testicular torsion. Academic Emergency Medicine. 2013 Mar 1;20(3):271-8.
Indradiputra IMU, Daryanto B, Seputra KP, Satyagraha P. Clinical Risk Factors for Non Salvageable Testis in Pediatric and Adult Testicular Torsion Patients. 32nd European Association of Urology Congress. London, United Kingdom. 2017
Boettcher M, Krebs T, Bergholz R, Wenke K, Aronson D, Reinshagen K. Clinical and Sonographic Features Predict Testicular Torsion in Children. BJU Int. 2013.112:1201-6.
Gajbhiye A S, Shamkuwar A, Surana K, Jivghale K, Soni MK. Surgical Management of Testicuar Torsion. Int Surg J. 2016 Feb;3(1):195-200.
FehÃ©r ÃM, Bajory Z. A Review of Main Controversial Aspects of Acute Testicular Torsion. J Acute Dis. 2016;5(1):1-8
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