Hisamatsu Eiji, Haruna Akiko, Sugita Yoshifumi, Tajima Motofumi, Yoshino Kaoru
Department of Urology, Aichi Children's Health and Medical Center, Japan.
Department of Urology, Kobe Children's Hospital, Japan.
J Pediatr Urol. 2022 Oct;18(5):684-690. doi: 10.1016/j.jpurol.2022.07.013. Epub 2022 Aug 5.
The Testicular Workup for Ischemia and Suspected Torsion (TWIST) score was created to help physicians in the clinical evaluation of acute scrotum in which testicular torsion (TT) is suspected. There have been only a few reports on validation of the TWIST score since the original study was published.
To validate the TWIST score as a scoring system.
We reviewed the records of 106 patients with acute scrotum in our prospectively maintained database. The patients were divided into two groups by the final diagnosis: testicular torsion (group TT) or non-testicular torsion (group NTT). We retrospectively calculated the TWIST score of the patients. Patients were divided into low (0-2), intermediate (3-4), or high (5-7) risk groups according to the total score.
Fifteen patients (14%) had TT. The median age at presentation was 13.3 years (range 1.6-16.2) in group TT and 10.4 years (range 0.25-18.9) in group NTT, respectively. The sensitivity of clinical and Color Doppler ultrasonography (CDUS) findings to diagnose TT was 100%, whereas the specificity was 93.4%. Positive predictive value (PPV) and negative predictive value (NPV) were 71.4% and 100%, respectively. According to the calculated TWIST score, 65, 23, and 18 patients belonged to low, intermediate, and high risk groups, respectively. TT was found in 1(1.3%), 3(13%), and 11 (61%) patients of low, intermediate, and high risk groups, respectively. The NPV of the TWIST score for the low risk group was 98.5%, whereas the PPV of the TWIST score for the high risk group was 61.1%. Among the four patients with TT in low risk and intermediate risk groups, three patients presented to our institutions within 6 h after the onset. The torsion was 180° in two of the three patients.
The TWIST score can be useful for clinical diagnosis of testicular torsion, but is inferior to clinical findings along with CDUS. We should consider the possibility that a TWIST score could be underestimated when patients present with acute scrotum immediately after onset or the affected testis is mildly twisted.
睾丸缺血及疑似扭转检查（TWIST）评分旨在帮助医生对疑似睾丸扭转（TT）的急性阴囊进行临床评估。自最初的研究发表以来，关于TWIST评分验证的报告仅有少数几篇。
验证TWIST评分作为一种评分系统的有效性。
我们回顾了前瞻性维护数据库中106例急性阴囊患者的记录。根据最终诊断将患者分为两组：睾丸扭转组（TT组）和非睾丸扭转组（NTT组）。我们回顾性计算了患者的TWIST评分。根据总分将患者分为低风险（0 - 2分）、中风险（3 - 4分）或高风险（5 - 7分）组。
15例患者（14%）患有TT。TT组患者就诊时的中位年龄为13.3岁（范围1.6 - 16.2岁），NTT组为10.4岁（范围0.25 - 18.9岁）。临床及彩色多普勒超声（CDUS）检查诊断TT的敏感性为100%，特异性为93.4%。阳性预测值（PPV）和阴性预测值（NPV）分别为71.4%和100%。根据计算出的TWIST评分，65、23和18例患者分别属于低风险、中风险和高风险组。低风险、中风险和高风险组中分别有1例（1.3%）、3例（13%）和11例（61%）患者患有TT。TWIST评分对低风险组的NPV为98.5%，对高风险组的PPV为61.1%。在低风险和中风险组的4例TT患者中，3例在发病后6小时内就诊于我们的机构。这3例患者中有2例扭转角度为180°。
TWIST评分对睾丸扭转的临床诊断可能有用，但不如临床检查及CDUS。当患者在发病后立即出现急性阴囊或患侧睾丸轻度扭转时，我们应考虑TWIST评分可能被低估的可能性。
