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Validation of a TWIST score in diagnosis of testicular torsion at Children’s Hospital Zagreb

BACKGROUNG: Testicular torsion is an emergency condition and it requires timely evaluation and surgical treatment to save the testicle. If testicular torsion goes on for more than a few hours, it can permanently damage the testicle, and a damaged testicle must be removed. Ultrasound is considered a method of choice, but it extends the time until the onset of an emergency operation. Barbosa et al. created Testicular Workup for Ischemia and Suspected Torsion (TWIST) score based on clinical parameters for clinical diagnosis of testicular torsion. We have evaluated this score in our population. MATERIALS AND METHODS: We retrospectively calculated TWIST score in patients of acute scrotum admitted to Children's Hospital Zagreb in the last four years. Patients without complete TWIST score were excluded from the study. The scoring system consisted of testicular swelling (2 points), hard testicle (2), absent cremasteric reflex (1), nausea/vomiting (1), and high‑riding testis (1). Clinical torsion was confirmed by surgical exploration. Statistical analysis was done to evaluate the validity of scores. RESULTS: A total of 298 patients were included in the study (out of which 79 patients were excluded from the study as complete details were not available to score them), out of which 43 (19.6%) (mean age 14.4 (range 2-18 years)) patients had testicular torsion. The mean duration of pain before patients with testicular torsion presented to our hospital was 9h. Cut off for low‑risk and high risk patients were two and five, respectively. 48.8 %, 36.9%, and 14.3% of patients were present in low‑, intermediate‑, and high‑risk groups. Negative predictive value of TWIST score for low‑risk patients was 94.5% while positive predictive value for high‑risk patients was 92.3%. CONCLUSION: TWIST score has high positive and negative predictive values and can be used as a clinical diagnostic tool for testicular torsion. Future large, multicenter, prospective studies are required for further validation of score.

testicular torsion ; TWIST score ; children ; pediatric surgery

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