João Arthur Brunhara Alves Barbosa1,2, Pedro Felipe Silva de Freitas3, Sergio Andurte Duarte Carvalho3, Augusto Quaresma Coelho3, Marco Aurelio Watanabe Yorioka3, Maykon William Aparecido Pereira3, Leonardo Lima Borges4, Miguel Srougi3, William C Nahas3, Marco Antonio Arap3,5. 1. Hospital das Clínicas da Faculdade de Medicina da USP - Urologia, University of Sao Paulo Medical School, Av Dr Eneas Carvalho Aguiar, 255 - 7o andar (Urologia), São Paulo, CEP, 05403-000, Brazil. jbrunhara@gmail.com. 2. Hospital Israelita Albert Einstein, Av Albert Einstein, 627. Building A1, Suite 409, Sao Paulo, CEP, 05652-900, Brazil. jbrunhara@gmail.com. 3. Hospital das Clínicas da Faculdade de Medicina da USP - Urologia, University of Sao Paulo Medical School, Av Dr Eneas Carvalho Aguiar, 255 - 7o andar (Urologia), São Paulo, CEP, 05403-000, Brazil. 4. Hospital Israelita Albert Einstein, Av Albert Einstein, 627. Building A1, Suite 409, Sao Paulo, CEP, 05652-900, Brazil. 5. Hospital Sirio Libanês, Rua Barata Ribeiro 387, Sao Paulo, SP, 01308-050, Brazil.
Abstract
PURPOSE: The TWIST (Testicular Work-up for Ischemia and Suspected Torsion) score was developed to allow for expedited diagnosis of testicular torsion (TT) in children based on clinical variables: edema (2 points), hard mass (2), absent cremasteric reflex (1), high-riding testis (1) and nausea/vomiting (1). We sought to validate the TWIST Score applied by non-expert physicians for the diagnosis of testicular torsion in an adult population. METHODS: We prospectively analyzed all consecutive males presenting to a tertiary hospital with acute scrotum. Patients with previous scrotal pathology or trauma were excluded. Physical examination was performed by a general surgeon and variables of TWIST were recorded. All patients underwent Scrotal Doppler Ultrasound. Measures of accuracy of the TWIST score and ROC curves were generated to evaluate its performance in diagnosing TT in adults. RESULTS: Of 68 patients, 34 had TT (50%). Median age was 24.9 years. According to the original cutoffs of TWIST, 23 patients had a score ≤ 2 among which none had TT. Fifteen patients had a score of 3-4, among which seven had TT. Thirty patients had a score ≥ 5, among which 27 had TT. All 18 patients with a score of 6 or greater had TT (100% PPV). ROC curve revealed an AUC of 0.95. CONCLUSION: The TWIST Score is valid for the diagnosis of Testicular Torsion in adults, presenting a PPV of 90% for a cutoff of 5 points and 100% for six points. In all patients with a score of 2 or less, the disease could be safely excluded (100% NPV).
PURPOSE: The TWIST (Testicular Work-up for Ischemia and Suspected Torsion) score was developed to allow for expedited diagnosis of testicular torsion (TT) in children based on clinical variables: edema (2 points), hard mass (2), absent cremasteric reflex (1), high-riding testis (1) and nausea/vomiting (1). We sought to validate the TWIST Score applied by non-expert physicians for the diagnosis of testicular torsion in an adult population. METHODS: We prospectively analyzed all consecutive males presenting to a tertiary hospital with acute scrotum. Patients with previous scrotal pathology or trauma were excluded. Physical examination was performed by a general surgeon and variables of TWIST were recorded. All patients underwent Scrotal Doppler Ultrasound. Measures of accuracy of the TWIST score and ROC curves were generated to evaluate its performance in diagnosing TT in adults. RESULTS: Of 68 patients, 34 had TT (50%). Median age was 24.9 years. According to the original cutoffs of TWIST, 23 patients had a score ≤ 2 among which none had TT. Fifteen patients had a score of 3-4, among which seven had TT. Thirty patients had a score ≥ 5, among which 27 had TT. All 18 patients with a score of 6 or greater had TT (100% PPV). ROC curve revealed an AUC of 0.95. CONCLUSION: The TWIST Score is valid for the diagnosis of Testicular Torsion in adults, presenting a PPV of 90% for a cutoff of 5 points and 100% for six points. In all patients with a score of 2 or less, the disease could be safely excluded (100% NPV).