ToolsCalculators
Testicular Workup for Ischemia and Suspected Torsion (TWIST)
Risk-stratifies acute scrotum for testicular torsion.
Testicular Workup for Ischemia and Suspected Torsion (TWIST)
Testicular swelling
Hard testis
Absent cremasteric reflex
Nausea or vomiting
High-riding testis
Result0 points
Low risk. Torsion unlikely; ultrasound may be avoidable.
- Risk group
- Low risk
When to use
- Risk-stratifying boys with acute scrotum to prioritise imaging versus direct surgical exploration.
Formula
Points: testicular swelling (2), hard testis (2), absent cremasteric reflex (1), nausea/vomiting (1), high-riding testis (1). 0-2 low, 3-4 intermediate, 5-7 high risk.
Pearls and pitfalls
- Derived and validated primarily in a paediatric male population.