Evaluation of the Diagnostic Performance of the Testicular Workup for Ischemia and Suspected Torsion (TWIST) Score for Assessing the Risk of Testicular Torsion in Adult Patients Presenting to the Emergency Department With Scrotal Pain - A Prospective Observational Study
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In plain language
An automatic summary of structured registry data. It is an orientation aid, not a substitute for the official protocol or a physician assessment.
- What is being studied
- This is an observational study: the protocol does not assign a study treatment.
- Who it may be relevant to
- Registry conditions: Testicular Torsion, Acute Scrotum, Scrotal Pain. Basic parameters: 18 years — 40 years · Male.
- What needs checking
- Age, condition and sex are only basic indicators. Prior treatment, laboratory values and other mandatory requirements appear in the eligibility criteria below.
- Where it takes place
- Sweden
- Next step
- Save the trial, show it to the treating physician, and confirm current recruitment with the study center. Costs, documents and travel →
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Official title
Evaluation of the Diagnostic Performance of the Testicular Workup for Ischemia and Suspected Torsion (TWIST) Score for Assessing the Risk of Testicular Torsion in Adult Patients Presenting to the Emergency Department With Scrotal Pain
Overview
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.
Detailed description
Acute scrotal pain is a common presentation in Emergency Departments, but the diagnosis of testicular torsion (TT) is relatively rare. Prompt identification is crucial because TT requires urgent surgical intervention to preserve testicular viability. Delays in diagnosis, particularly due to unnecessary imaging or non-standardized clinical assessment, may result in testicular loss.
The TWIST (Testicular Workup for Ischemia and Suspected Torsion) score is a clinical decision tool developed and validated in pediatric populations to stratify risk of TT based on five clinical features: testicular swelling, hard testis, high-riding testis, absent cremasteric reflex, and nausea/vomiting. Adult validation is limited, and no large-scale multicenter study has evaluated its performance in adult Emergency Department settings in Sweden.
This study will prospectively collect structured clinical data from adult patients aged 18-40 years presenting with scrotal pain at participating Swedish EDs. The TWIST score will be calculated from documented clinical findings. The study does not influence clinical management; patients will receive standard care, including imaging or surgical intervention as deemed appropriate by treating clinicians.
Primary objectives focus on the diagnostic accuracy of TWIST for ruling out TT in low-risk patients, while secondary objectives include assessment of the score in identifying high-risk patients, measurement of time to surgery, evaluation of pain scores, and analysis of imaging utilization. Data will also be linked to the Swedish Perioperative Register (SPOR) for outcomes such as surgery performed, complications, and final diagnoses.
The study is designed to evaluate whether structured use of TWIST can support evidence-based, standardized risk stratification in adults, potentially improving patient outcomes, streamlining resource use, and reducing unnecessary delays in diagnosis and treatment. Ethical oversight is provided by the Swedish Ethical Review Authority (Etikprövningsmyndigheten, decision 2025-07400-01).
Primary outcome measures
- Diagnostic Accuracy of the TWIST Score (Low-Risk Group) [Time frame: Up to 30 days from ED visit]
Secondary outcome measures (4)
- Time to exploration [Time frame: 30 days from ED visit]
- Testicular torsion [Time frame: 30 days from inclusion]
- Pain at study inclusion [Time frame: Up to one hour from inclusion in the study.]
- Use of Ultrasound [Time frame: Up to 48 hours from inclusion or ED discharge, whichever comes first]
Eligibility criteria
Inclusion criteria
- Male patients aged 18-40 years
Presenting to the Emergency Department with acute scrotal pain or scrotal symptoms
Suspicion of testicular torsion before clinical assessment
Exclusion criteria
- Scrotal pain or symptoms caused by trauma
Symptom duration > 1 week
History of testicular surgery
Inability to provide informed consent (e.g., language barrier or cognitive limitation)
Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.
Healthy volunteers: No
Study design
- Observational model
- Cohort
Study locations
Sweden · 1 center
- Linköping University Hospital, ED — Linköping
Identifiers
NCT: NCT07499024 · 2025-07400-01 · 2025-07400-01