How is the Testicular Workup for Ischemia and Suspected Torsion (TWIST) scoring system used to determine risk for testicular torsion?

Updated: Aug 31, 2018
  • Author: Oreoluwa I Ogunyemi, MD; Chief Editor: Edward David Kim, MD, FACS  more...
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Based on TWIST scores, patients are classified as being at low, intermediate, or high risk. TWIST has shown 100% negative predictive value when scored by a urologist, using a cutoff value of 2 to identify low-risk patients, and when scored by trained emergency medical technicians (EMTs) using a cutoff of 0 in children. [24, 23] Cutoff values of 5 (scored by a urologist) and 6 (EMTs) have been used to identify high-risk patients. Ultrasound evaluation is indicated for intermediate-risk patients; low-risk patients do not require ultrasound to rule out torsion, and patients at high risk can proceed directly to surgery, with more than 50% avoiding ultrasound. [24]

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