Please use this identifier to cite or link to this item: https://ahro.austin.org.au/austinjspui/handle/1/28932
Title: Diagnosing with a TWIST: Systematic Review and Meta-Analysis of a Testicular Torsion Risk Score.
Austin Authors: Qin, Kirby R ;Qu, Liang G 
Affiliation: Urology
Department of Paediatrics, Monash University, Clayton, Victoria, Australia..
Young Urology Researchers Organisation (YURO), Melbourne, Australia..
Issue Date: 3-Mar-2022
Date: 2022-03-03
Publication information: The Journal of Urology 2022; 208(1): 62-70
Abstract: The Testicular Workup for Ischaemia and Suspected Torsion (TWIST) score is a seven-point tool to evaluate acute scrotal pain. Parameters include testicular swelling (2 points), hard testis (2), high-riding testis (1), absent cremasteric reflex (1), and nausea/vomiting (1). This review aimed to determine the diagnostic utility of TWIST and its role in risk stratification. A systematic review and meta-analysis of diagnostic test accuracy (MADTA) was conducted. Five risk stratification systems were explored, including Barbosa 2013 (0-2/3-4/5-7) and Sheth 2016 (0/1-5/6-7), to obtain sensitivity, specificity, and area under the receiver operating curve (AUC). Thirteen studies were identified, nine prospective studies proceeded to MADTA, five paediatric studies (1060 patients, 199 torsions) were included in the primary analysis. The most accurate risk stratification system was Barbosa (0-2/3-4/5-7) with an AUC of 0.924 [95% CI: 0.865, 0.956]. Barbosa showed favourable sensitivity in low-risk patients (0.984), facilitating rule-out of torsion, and favourable specificity (0.975) in high-risk patients, facilitating urgent surgical exploration. Sensitivity and specificity in intermediate-risk patients were 0.922 and 0.682, respectively, indicating a need for further workup with ultrasound. Using this stratification, 65.2% of patients were low-risk, 19.9% were intermediate-risk, and 14.9% were high-risk. Per 100 presentations of acute scrotum, there was a missed torsion rate of 1.6/100, ultrasound rate of 19.9/100, and negative exploration rate of 2.5/100. TWIST is an effective tool for suspected testicular torsion and is appropriate for widespread adoption. The Barbosa scoring system is reliable and reduces the reliance on scrotal ultrasound.
URI: https://ahro.austin.org.au/austinjspui/handle/1/28932
DOI: 10.1097/JU.0000000000002496
ORCID: 0000-0001-5215-5985
0000-0002-5710-1983
Journal: The Journal of urology
PubMed URL: 35238603
PubMed URL: https://pubmed.ncbi.nlm.nih.gov/35238603/
Type: Journal Article
Subjects: TWIST score
acute scrotum
diagnostic test accuracy
meta-analysis
scrotal ultrasound
systematic review
testicular torsion
Appears in Collections:Journal articles

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