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
SCORE
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.
Reference:
Frohlich LC et al Acad Emerg Med 2017
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