TWIST Score for Testicular Torsion
Testicular Workup for Ischaemia and Suspected Torsion (TWIST) score to guide immediate scrotal exploration vs USS in suspected testicular torsion.
Score interpretation
TWIST 0–2: Low risk of testicular torsion. Colour Doppler USS recommended before decision.
→ Urgent scrotal Doppler USS (< 4 hours). If torsion confirmed on USS: emergency scrotal exploration. If USS negative but clinical suspicion remains: explore anyway. Do NOT delay exploration for USS if USS not immediately available and clinical suspicion is high.
TWIST 3–4: Intermediate risk. USS should not delay surgical management if torsion strongly suspected.
→ Urgent USS if immediately available (< 1 hour). Surgical team must be informed and ready. If USS unavailable or delayed: proceed directly to scrotal exploration. Consent for orchidopexy ± orchidectomy. NBM. IV access.
TWIST ≥ 5: High risk of testicular torsion. Immediate scrotal exploration without USS.
→ DO NOT wait for USS. IMMEDIATE surgical exploration. Salvage rate: ~90% if < 6h; ~50% at 12h; ~10% at 24h. Consent for bilateral orchidopexy (affected + contralateral). NBM and fast-track to theatre. Urology on-call STAT. Inform patient and parents (if paediatric).
Interpretation bands for the TWIST. Apply clinical judgement and local guidance.
References
- Barbosa JA et al. Optimizing the management of acute scrotum in children: comparative analysis of the Testicular Workup for Ischemia and Suspected Torsion score, Doppler ultrasound, and surgical exploration. J Urol. 2012.
- EAU Guidelines on Paediatric Urology. 2023.
Related
Curated clinical cross-links plus same-class fallbacks.
- Methoxyflurane · Inhaled Analgesic — Acute Pain
- Fentanyl Transdermal Patch (Elderly Chronic Pain) · Opioid Analgesic — Transdermal Patch
- Morphine Slow-Release (Elderly Chronic Pain) · Opioid Analgesic — Modified-Release Oral
- Amitriptyline (Neuropathic Pain / Migraine) · Tricyclic Antidepressant / Neuropathic Pain Agent
- Gabapentin · Alpha-2-Delta Ligand — Neuropathic Pain / Epilepsy Adjunct
- Diclofenac (Dysmenorrhoea / Post-gynaecological Procedure) · NSAID — Gynaecological Pain
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.