Risk of missed testicular torsions using the twist-score?
Marie Andersson, Canan Yasar, Pia Löfgren, Martin SalöAbstract
Introduction
The main decision in pediatric acute scrotum is to decide if the boy has testicular torsion (TT). TWIST-score is validated and a metaanalysis deemed the Barbosastratification (0–2, 3–4, 5–7) most reliable with no low risk (0–2) patients having TT. We aimed to evaluate the accuracy of this stratification in our setting.
Methods
A multicenter prospective study between 2019–2022 including boys between 2 weeks-16 years with ≤5 days of symptoms. In a second stage, boys who underwent acute scrotal exploration during 2019–2022 were analyzed. The diagnosis of TT was defined as detorsion of, or ischemic, testis.
Results
317 boys were included prospectively and 30 boys retrospectively. Median age was 12 years. Ultrasound was performed in 39% (124/317) of cases and 35% (112/317) were explored. Negative exploration rate was 29% (32/112). The other 80 boys had confirmed TT/ suspected intermittent TT/Bell clapper deformity. There were 22% (69/317) confirmed TT. Among these, 17 (25%) had low-risk (0–2), 17 (25%) intermediate risk, and 35 (51%) a high-risk score. In the retrospective group 53% (16/30) TT were identified of which 1 (6%) had a low-risk score. In the low-risk group, ultrasound was performed in 4/17 and surgical decision was based on the pain characteristics (n = 15) and ultrasound (n = 2).
Discussion
TWIST-score is useful when utilized as intended: to minimize ultrasounds in low-score, and delay of surgery in high-score, patients. However, low scores should not be interpreted as ‘no risk of TT’ since 1/3 in this cohort would have been missed. Other parameters must be a part in the decision of exploration.