Predictive value of the TWIST score for testicular salvageability in pediatric testicular torsion

Acute scrotal pain in pediatric patients is frequently caused by testicular torsion, a critical condition requiring urgent diagnosis and treatment to avoid testicular loss. The Testicular Workup for Ischemia and Suspected Torsion (TWIST) score provides a clinical method for rapid diagnosis, potentially minimizing diagnostic delays and reliance on imaging. This study evaluates the accuracy and predictive value of the TWIST score for testicular salvageability in pediatric acute scrotum cases. This retrospective study included 28 male patients under 18 years diagnosed with testicular torsion at XXX Education and Research Hospital. Patient demographics, clinical features, TWIST scores, timing of emergency department visits, imaging, and surgical outcomes were analyzed. Patients were classified by TWIST scores into low (0–2), medium (3–4), and high (5–7) risk categories. Statistical analysis was performed using ROC curves to assess diagnostic accuracy. The median patient age was 11 years. In this torsion-only cohort, the TWIST score showed good discrimination between salvageable and non-salvageable testes (AUC 0.928, 95% CI 0.830–1.000). A cut-off value of 4.5 was associated with a higher probability of testicular loss, although several patients with preserved testes also had high TWIST scores. Patients with non-salvageable testes had significantly longer delays before emergency department presentation compared to those whose testes were preserved (p < 0.001). Within our sample of children with confirmed torsion, higher TWIST scores were associated with an increased risk of testicular loss, but symptom duration remained the main determinant of outcome. The TWIST score should therefore be interpreted together with the time from symptom onset, and prospective multi-center studies including non-torsion controls are needed to validate these preliminary findings.