Validation of the TWIST score for testicular torsion in adults.

Autor: Barbosa JABA; Hospital das Clínicas da Faculdade de Medicina da USP - Urologia, University of Sao Paulo Medical School, Av Dr Eneas Carvalho Aguiar, 255 - 7o andar (Urologia), São Paulo, CEP, 05403-000, Brazil. jbrunhara@gmail.com.; Hospital Israelita Albert Einstein, Av Albert Einstein, 627. Building A1, Suite 409, Sao Paulo, CEP, 05652-900, Brazil. jbrunhara@gmail.com., de Freitas PFS; Hospital das Clínicas da Faculdade de Medicina da USP - Urologia, University of Sao Paulo Medical School, Av Dr Eneas Carvalho Aguiar, 255 - 7o andar (Urologia), São Paulo, CEP, 05403-000, Brazil., Carvalho SAD; Hospital das Clínicas da Faculdade de Medicina da USP - Urologia, University of Sao Paulo Medical School, Av Dr Eneas Carvalho Aguiar, 255 - 7o andar (Urologia), São Paulo, CEP, 05403-000, Brazil., Coelho AQ; Hospital das Clínicas da Faculdade de Medicina da USP - Urologia, University of Sao Paulo Medical School, Av Dr Eneas Carvalho Aguiar, 255 - 7o andar (Urologia), São Paulo, CEP, 05403-000, Brazil., Yorioka MAW; Hospital das Clínicas da Faculdade de Medicina da USP - Urologia, University of Sao Paulo Medical School, Av Dr Eneas Carvalho Aguiar, 255 - 7o andar (Urologia), São Paulo, CEP, 05403-000, Brazil., Pereira MWA; Hospital das Clínicas da Faculdade de Medicina da USP - Urologia, University of Sao Paulo Medical School, Av Dr Eneas Carvalho Aguiar, 255 - 7o andar (Urologia), São Paulo, CEP, 05403-000, Brazil., Borges LL; Hospital Israelita Albert Einstein, Av Albert Einstein, 627. Building A1, Suite 409, Sao Paulo, CEP, 05652-900, Brazil., Srougi M; Hospital das Clínicas da Faculdade de Medicina da USP - Urologia, University of Sao Paulo Medical School, Av Dr Eneas Carvalho Aguiar, 255 - 7o andar (Urologia), São Paulo, CEP, 05403-000, Brazil., Nahas WC; Hospital das Clínicas da Faculdade de Medicina da USP - Urologia, University of Sao Paulo Medical School, Av Dr Eneas Carvalho Aguiar, 255 - 7o andar (Urologia), São Paulo, CEP, 05403-000, Brazil., Arap MA; Hospital das Clínicas da Faculdade de Medicina da USP - Urologia, University of Sao Paulo Medical School, Av Dr Eneas Carvalho Aguiar, 255 - 7o andar (Urologia), São Paulo, CEP, 05403-000, Brazil.; Hospital Sirio Libanês, Rua Barata Ribeiro 387, Sao Paulo, SP, 01308-050, Brazil.
Jazyk: angličtina
Zdroj: International urology and nephrology [Int Urol Nephrol] 2021 Jan; Vol. 53 (1), pp. 7-11. Date of Electronic Publication: 2020 Aug 25.
DOI: 10.1007/s11255-020-02618-4
Abstrakt: Purpose: The TWIST (Testicular Work-up for Ischemia and Suspected Torsion) score was developed to allow for expedited diagnosis of testicular torsion (TT) in children based on clinical variables: edema (2 points), hard mass (2), absent cremasteric reflex (1), high-riding testis (1) and nausea/vomiting (1). We sought to validate the TWIST Score applied by non-expert physicians for the diagnosis of testicular torsion in an adult population.
Methods: We prospectively analyzed all consecutive males presenting to a tertiary hospital with acute scrotum. Patients with previous scrotal pathology or trauma were excluded. Physical examination was performed by a general surgeon and variables of TWIST were recorded. All patients underwent Scrotal Doppler Ultrasound. Measures of accuracy of the TWIST score and ROC curves were generated to evaluate its performance in diagnosing TT in adults.
Results: Of 68 patients, 34 had TT (50%). Median age was 24.9 years. According to the original cutoffs of TWIST, 23 patients had a score ≤ 2 among which none had TT. Fifteen patients had a score of 3-4, among which seven had TT. Thirty patients had a score ≥ 5, among which 27 had TT. All 18 patients with a score of 6 or greater had TT (100% PPV). ROC curve revealed an AUC of 0.95.
Conclusion: The TWIST Score is valid for the diagnosis of Testicular Torsion in adults, presenting a PPV of 90% for a cutoff of 5 points and 100% for six points. In all patients with a score of 2 or less, the disease could be safely excluded (100% NPV).
Databáze: MEDLINE
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