Klin Padiatr 2019; 231(04): 217-219
DOI: 10.1055/a-0826-4885
Short Communication
© Georg Thieme Verlag KG Stuttgart · New York

Validation of a TWIST Score In Diagnosis of Testicular Torsion – Single-Center Experience

Validierung des TWIST Scores bei der Diagnose der Hodentorsion – Erfahrungen eines Einzelzentrums
Marko Bašković
1  Department of Pediatric Surgery, Children’s Hospital Zagreb, Zagreb, Croatia
,
Božidar Župančić
1  Department of Pediatric Surgery, Children’s Hospital Zagreb, Zagreb, Croatia
,
Ivo Vukasović
2  University of Zagreb, School of Medicine, Zagreb, Croatia
,
Ivan Štimac-Rojtinić
2  University of Zagreb, School of Medicine, Zagreb, Croatia
,
Davor Ježek
3  School of Medicine, Department of Histology and Embryology, University of Zagreb, Zagreb, Croatia
› Author Affiliations
Further Information

Publication History

Publication Date:
21 January 2019 (online)

Introduction

The most common causes of acute scrotal pain in children and adolescents include testicular torsion, torsion of the appendix testis, and epididymitis. Testicular torsion is the most dramatic and potentially serious of the acute processes affecting the scrotal contents because it may result in the loss of the testicle. The incidence is estimated to be 1 in 4000 in males younger than 25 years old (Williamson RC. Br J Surg 1976; 63(6): 465–476.). Approximately 65 percent of cases occur in boys between the ages of 12 and 18 years (Edelsberg JS et al., Emerg Med Clin North Am. 1988; 6(3): 521–546.). In a prospective study (Barbosa JA et al., J Urol. 2013; 189(5): 1859–1864.) of 338 children with an acute scrotum evaluated at a single institution, the following clinical scoring system for testicular torsion was derived: nausea or vomiting – 1 point, testicular swelling - 2 points, hard testis on palpation – 2 points, high riding testis – 1 point, absent cremasteric reflex – 1 point. A score ≥5 diagnosed testicular torsion with a sensitivity of 76%, specificity of 100%, and a positive predictive value of 100% (prevalence 15%). A score ≤2 excluded testicular torsion with a sensitivity of 100%, a specificity of 82%, and a negative predictive value of 100%. This study support the practice of early surgical consultation for children in whom testicular torsion is strongly suspected based upon history and physical examination rather than performing imaging.