TWIST score

The Testicular Workup for Ischemia and Suspected Torsion (TWIST) score is a clinical decision tool used for the workup and management of acute scrotal emergencies where torsion is suspected. It uses history and examination to estimate the likelihood of torsion. It aims to reduce the number of unnecessary ultrasounds in cases of suspected torsion.


  • testicular swelling (two points)
  • hard testes (two points)
  • absent cremasteric reflex (one point)
  • nausea or vomiting (one point)
  • high riding testicle (one point)


  • score 0-2: low risk
    • 100% negative predictive value for torsion
    • generally no ultrasound or urological consultation required
  • score 3-5: intermediate risk
    • ultrasound warranted
  • score >5: high risk
    • 100% positive predictive value for torsion
    • ultrasound not required, urgent urological consultation and surgery required to salvage testicle
Share article

Article information

rID: 66554
System: Urogenital
Synonyms or Alternate Spellings:
  • TWIST score

Support Radiopaedia and see fewer ads

Updating… Please wait.

 Unable to process the form. Check for errors and try again.

 Thank you for updating your details.