• The Review Course in Family Medicine

Testicular Torsion TWIST Score

by Dr. Mike Kirlew MD CCFP

The TWIST Score has been validated in a pediatric population with non-urologists.

The TWIST score (Testicular Workup for Ischemia and Suspected Torsion)

Testicular Swelling - 2 points

Hard Testes - 2 points

Absent cremasteric reflex - 1 point

Nausea/vomiting - 1 point

High-riding testes - 1 point


  • 0-2 LOW RISK - 100% negative predictive value for torsion

  • 3-4 MEDIUM RISK - Order Testicular Ultrasound

  • >5 HIGH RISK - 100% positive predictive value for torsion - Urgent Urology Consult, no ultrasound required.

Remember the TWIST.


Frohlich LC et al Acad Emerg Med 2017

Highly Rated - Thousands of Attendees
  • Facebook
  • Twitter
  • Instagram

© The Review Course in Family Medicine Inc. | About Us | Privacy Policy

The only Canada-Wide CCFP exam course - created by two Family Doctors who wished this existed when we were residents, and are on a mission to help CCFP exam candidates. Disclosures: The Review Course founders have no conflicting commercial interests. As is the case with any private events hosted on a university campus or hospital, this event is not affiliated with nor endorsed by the host venues. Our materials are peer-reviewed and prepared by Canadian physicians; we do not guarantee that our preparation materials are representative of any Canadian examination and we do not provide questions from any other examination nor are they intended as medical advice. The College of Family Physicians of Canada does not affiliate with nor endorse any exam preparation course.