The Effect of Age and Symptom Duration on the Accuracy of Twist Score for Testicular Torsion in Boys.

OBJECTIVE

To study the effect of age and duration of symptoms on accuracy of TWIST score in diagnosing testicular torsion (TT) in boys presenting with acute scrotal pain.

METHODS

Data was prospectively recorded between January 2023 to January 2024 from a tertiary pediatric surgical centre. Inclusion criteria included all boys aged 1-16 years of age who presented with acute scrotal pain and had a TWIST score assessment. Boys with previous scrotal surgery and those without a TWIST score assessment were excluded. Based on TWIST score, boys were divided into low, intermediate and high-risk groups for TT. Diagnostic accuracy of TWIST was assessed based on age (<12yrs vs≥12yrs) and duration of symptoms (≤8 h, 8-24 h, >24 h) using reciever operator characteristic (ROC) analysis and reported as area under curve (AUC).

RESULTS

One hundred patients were included in this study, with low risk = 61, intermediate risk = 15 and high risk = 24 patients. The median age of the whole cohort was 12 years (IQR: 8.8-13 years) with <12 yrs = 44 and ≥ 12 yrs = 56. The median time from onset of symptoms to presentation was 14 h (IQR: 7.3-41 h) with≤8 h = 26, 8-24 h = 44, >24 h = 29. Excluding the intermediate risk group (n = 15), TWIST had an overall sensitivity, specificity, PPV and NPV of 100 %, 83.6 %, 53.7 % and 100 % respectively. ROC analysis of TWIST score for the entire cohort showed an AUC of 0.917 (95 % CI: 0.822-1.000). AUC did not differ for <12 yrs (0.93) vs > 12 yrs (0.92) but did show a gradual decline with increasing duration of symptoms; ≤8 h (0.97), 8-24 h (0.92) and >24 h (0.78) but this was not significant.

CONCLUSIONS

We give further support to the utility of the TWIST score in the management of children presenting with acute scrotal pain. We found that neither age nor duration of symptoms significantly affected TWIST score's accuracy.