• 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


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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