This prospective multicenter observational study aims to evaluate the diagnostic accuracy of the Testicular Workup for Ischemia and Suspected Torsion (TWIST) score in adult patients presenting with acute scrotal pain in Swedish Emergency Departments.
The TWIST score is a clinical decision tool originally validated in pediatric populations to stratify patients into low, intermediate, and high risk for testicular torsion. The study will include men aged 18-40 years presenting with scrotal pain or symptoms suggestive of torsion. Patients with scrotal trauma, symptom duration over one week, previous testicular surgery, or inability to give informed consent in Swedish will be excluded.
Participants' clinical findings will be recorded on a standardized form, and the TWIST score will be calculated. Management will follow standard clinical practice independently of the study. Primary outcome is the diagnostic accuracy of the TWIST score to rule out testicular torsion in low-risk patients (TWIST 0-2). Secondary outcomes include diagnosis of torsion within 30 days, time to surgery, patient-reported pain, number of Doppler ultrasounds performed, and the potential reduction in unnecessary imaging.
The study will be conducted at multiple Swedish sites, including Linköping University Hospital, under oversight by the Swedish Ethical Review Authority (Etikprövningsmyndigheten, decision number 2025-07400-01). The results aim to inform clinical practice by providing a validated decision-support tool for adult patients with suspected testicular torsion, potentially improving patient outcomes and resource utilization.
Male patients aged 18-40 years
Scrotal pain or symptoms caused by trauma
The study population consists of adult men aged 18-40 years presenting to participating Emergency Departments in Sweden with acute scrotal pain or scrotal symptoms suggestive of testicular torsion. Patients with trauma-related scrotal pain, symptom duration longer than one week, previous testicular surgery, or inability to provide informed consent are excluded. The study aims to evaluate the diagnostic accuracy of the TWIST score in a real-world adult ED population.
Cohort
Prospective
Not listed
Diagnostic Accuracy of the TWIST Score (Low-Risk Group)
Number and proportion of adult patients with a low-risk TWIST score (0-2) who are confirmed not to have testicular torsion based on surgical exploration or follow-up within 30 days. This measures the sensitivity of the TWIST score to safely rule out torsion.
Time to exploration
Time in hours from patient arrival in the Emergency Department to surgical intervention for suspected testicular torsion.
Testicular torsion
Number of testicular torsions found up to 30 days from ED visit
Pain at study inclusion
Pain at inclusion to the study measured by NRS
Use of Ultrasound
If ultrasound was used during the Emergency Department visit
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University Hospital, Linkoeping
Lead sponsor
Linkoeping University
Collaborator
