The Testicular Workup for Ischaemia and Suspected Torsion (TWIST) score is a clinical decision tool used for the workup and management of acute scrotal emergencies where testicular torsion is suspected. It uses history and examination to estimate the likelihood of torsion. Validation of the clinical score has only been conducted in the paediatric population. The TWIST score aims to reduce the number of unnecessary ultrasounds in cases of suspected torsion.
Criteria
testicular swelling (two points)
hard testis (two points)
absent cremasteric reflex (one point)
nausea or vomiting (one point)
high riding testis (one point)
Interpretation
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score 0-2: low risk
100% negative predictive value for torsion
generally no ultrasound or urological consultation required
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score 3-4: intermediate risk
ultrasound warranted
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score 5 or above: high risk
100% positive predictive value for torsion
ultrasound not required, urgent urological consultation and surgery required to salvage testis
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