Diagnosing Testicular Torsion before Urological Consultation and Imaging: Validation of the TWIST Score
2016; Lippincott Williams & Wilkins; Volume: 195; Issue: 6 Linguagem: Inglês
10.1016/j.juro.2016.01.101
ISSN1527-3792
AutoresKunj R. Sheth, Mélise Keays, Gwen M. Grimsby, Candace F. Granberg, Vani S. Menon, Daniel DaJusta, Lauren Ostrov, Martinez Hill, Emma Sanchez, David Kuppermann, Clanton B. Harrison, Micah A. Jacobs, Rong Huang, Berk Burgu, Halim Hennes, Bruce J. Schlomer, Linda A. Baker,
Tópico(s)Urologic and reproductive health conditions
ResumoNo AccessJournal of UrologyPediatric Urology1 Jun 2016Diagnosing Testicular Torsion before Urological Consultation and Imaging: Validation of the TWIST Score Kunj R. Sheth, Melise Keays, Gwen M. Grimsby, Candace F. Granberg, Vani S. Menon, Daniel G. DaJusta, Lauren Ostrov, Martinez Hill, Emma Sanchez, David Kuppermann, Clanton B. Harrison, Micah A. Jacobs, Rong Huang, Berk Burgu, Halim Hennes, Bruce J. Schlomer, and Linda A. Baker Kunj R. ShethKunj R. Sheth University of Texas Southwestern Medical Center, Dallas, Texas , Melise KeaysMelise Keays Children's Hospital of East Ontario, Ottawa, Ontario, Canada , Gwen M. GrimsbyGwen M. Grimsby Phoenix Children's Hospital, Phoenix, Arizona , Candace F. GranbergCandace F. Granberg Mayo Clinic, Rochester, Minnesota , Vani S. MenonVani S. Menon University of Texas Southwestern Medical Center, Dallas, Texas Children's Health, Dallas, Texas , Daniel G. DaJustaDaniel G. DaJusta Harvard Medical School, Boston, Massachusetts , Lauren OstrovLauren Ostrov Children's Health, Dallas, Texas , Martinez HillMartinez Hill Children's Health, Dallas, Texas , Emma SanchezEmma Sanchez Children's Health, Dallas, Texas , David KuppermannDavid Kuppermann Ankara Üniversitesi Tıp Fakültesi, Ankara, Turkey , Clanton B. HarrisonClanton B. Harrison University of Texas Southwestern Medical Center, Dallas, Texas Children's Health, Dallas, Texas , Micah A. JacobsMicah A. Jacobs University of Texas Southwestern Medical Center, Dallas, Texas Children's Health, Dallas, Texas , Rong HuangRong Huang Children's Health, Dallas, Texas , Berk BurguBerk Burgu Nationwide Children's Hospital, Columbus, Ohio , Halim HennesHalim Hennes University of Texas Southwestern Medical Center, Dallas, Texas Children's Health, Dallas, Texas , Bruce J. SchlomerBruce J. Schlomer University of Texas Southwestern Medical Center, Dallas, Texas Children's Health, Dallas, Texas , and Linda A. BakerLinda A. Baker University of Texas Southwestern Medical Center, Dallas, Texas Children's Health, Dallas, Texas View All Author Informationhttps://doi.org/10.1016/j.juro.2016.01.101AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: The TWIST (Testicular Workup for Ischemia and Suspected Torsion) score uses urological history and physical examination to assess risk of testis torsion. Parameters include testis swelling (2 points), hard testis (2), absent cremasteric reflex (1), nausea/vomiting (1) and high riding testis (1). While TWIST has been validated when scored by urologists, its diagnostic accuracy among nonurological providers is unknown. We assessed the usefulness of the TWIST score when determined by nonurological nonphysician providers, mirroring emergency room evaluation of acute scrotal pain. Materials and Methods: Children with unilateral acute scrotum were prospectively enrolled in a National Institutes of Health clinical trial. After undergoing basic history and physical examination training, emergency medical technicians calculated TWIST score and determined Tanner stage per pictorial diagram. Clinical torsion was confirmed by surgical exploration. All data were captured into REDCap™ and ROC curves were used to evaluate the diagnostic usefulness of TWIST. Results: Of 128 patients (mean age 11.3 years) 44 (13.0 years) had torsion. TWIST score cutoff values of 0 and 6 derived from ROC analysis identified 31 high, 57 intermediate and 40 low risk cases (positive predictive value 93.5%, negative predictive value 100%). Conclusions: TWIST score assessed by nonurologists, such as emergency medical technicians, is accurate. Low risk patients do not require ultrasound to rule out torsion. 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Google Scholar © 2016 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byQin K and Qu L (2022) Diagnosing with a TWIST: Systematic Review and Meta-Analysis of a Testicular Torsion Risk ScoreJournal of Urology, VOL. 208, NO. 1, (62-70), Online publication date: 1-Jul-2022.Schlomer B, Keays M, Grimsby G, Granberg C, DaJusta D, Menon V, Ostrov L, Sheth K, Hill M, Sanchez E, Harrison C, Jacobs M, Huang R, Burgu B, Hennes H and Baker L (2017) Transscrotal Near Infrared Spectroscopy as a Diagnostic Test for Testis Torsion in Pediatric Acute Scrotum: A Prospective Comparison to Gold Standard Diagnostic Test StudyJournal of Urology, VOL. 198, NO. 3, (694-701), Online publication date: 1-Sep-2017.Dias Filho A, Oliveira Rodrigues R, Riccetto C and Oliveira P (2016) Improving Organ Salvage in Testicular Torsion: Comparative Study of Patients Undergoing vs Not Undergoing Preoperative Manual DetorsionJournal of Urology, VOL. 197, NO. 3 Part 1, (811-817), Online publication date: 1-Mar-2017.Barbosa J, Denes F and Nguyen H (2016) Testicular Torsion—Can We Improve the Management of Acute Scrotum?Journal of Urology, VOL. 195, NO. 6, (1650-1651), Online publication date: 1-Jun-2016.Cain M (2016) This Month in Pediatric UrologyJournal of Urology, VOL. 195, NO. 6, (1636-1636), Online publication date: 1-Jun-2016. Volume 195Issue 6June 2016Page: 1870-1876 Advertisement Copyright & Permissions© 2016 by American Urological Association Education and Research, Inc.Keywordsspermatic cord torsiondiagnosisultrasonographyscrotumMetricsAuthor Information Kunj R. Sheth University of Texas Southwestern Medical Center, Dallas, Texas More articles by this author Melise Keays Children's Hospital of East Ontario, Ottawa, Ontario, Canada More articles by this author Gwen M. Grimsby Phoenix Children's Hospital, Phoenix, Arizona More articles by this author Candace F. Granberg Mayo Clinic, Rochester, Minnesota More articles by this author Vani S. Menon University of Texas Southwestern Medical Center, Dallas, Texas Children's Health, Dallas, Texas More articles by this author Daniel G. DaJusta Harvard Medical School, Boston, Massachusetts More articles by this author Lauren Ostrov Children's Health, Dallas, Texas More articles by this author Martinez Hill Children's Health, Dallas, Texas More articles by this author Emma Sanchez Children's Health, Dallas, Texas More articles by this author David Kuppermann Ankara Üniversitesi Tıp Fakültesi, Ankara, Turkey More articles by this author Clanton B. Harrison University of Texas Southwestern Medical Center, Dallas, Texas Children's Health, Dallas, Texas More articles by this author Micah A. Jacobs University of Texas Southwestern Medical Center, Dallas, Texas Children's Health, Dallas, Texas More articles by this author Rong Huang Children's Health, Dallas, Texas More articles by this author Berk Burgu Nationwide Children's Hospital, Columbus, Ohio More articles by this author Halim Hennes University of Texas Southwestern Medical Center, Dallas, Texas Children's Health, Dallas, Texas More articles by this author Bruce J. Schlomer University of Texas Southwestern Medical Center, Dallas, Texas Children's Health, Dallas, Texas More articles by this author Linda A. Baker University of Texas Southwestern Medical Center, Dallas, Texas Children's Health, Dallas, Texas Supported by NIH Grant R21DK092654. More articles by this author Expand All Advertisement PDF downloadLoading ...
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