How well the TWIST score predicts testicular torsion in adults with sudden scrotal pain
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
Run by University Hospital, Linkoeping · NCT07499024 · Data updated 2026-11-12
We will test whether the TWIST score can safely rule out testicular torsion in men aged 18–40 who come to the emergency department with scrotal pain.
Quick facts
| Study type | Observational |
|---|---|
| Ages | 18 Years to 40 Years |
| Sex | Men only |
| Enrollment | 1000 (estimated) |
| Sponsor | University Hospital, Linkoeping Academic / other |
| Locations | 1 site (Linköping, Östergötland County) |
| Status | Recruiting |
| Started | February 1, 2026 |
| Main results expected | January 31, 2028 |
| Study ends | December 31, 2029 |
| Registry record updated | April 29, 2026 |
| Trial ID | NCT07499024 on ClinicalTrials.gov |
Is this trial a fit for you?
✓Likely a good fit
Men aged 18–40 who present to the emergency department with acute scrotal pain or symptoms suggestive of torsion, who can give informed consent in Swedish, and who do not have scrotal trauma or prior testicular surgery and have symptoms of less than one week.
✕Probably not a fit
Patients outside the 18–40 age range, those with scrotal trauma, symptom duration over one week, prior testicular surgery, or inability to consent in Swedish are unlikely to gain direct benefit from this study's findings.
A plain-English reading of the study's rules. Only the study team can confirm whether you qualify.
What this trial studies
This prospective observational study will collect standardized clinical findings from men aged 18–40 presenting with acute scrotal pain at participating Swedish emergency departments and calculate the TWIST score for each patient. The TWIST score combines five clinical signs (testicular swelling, hard testis, high-riding testis, absent cremasteric reflex, and nausea/vomiting) to stratify patients into low, intermediate, and high risk. Clinical care, including imaging and surgery, will follow routine practice and is not dictated by the study. The primary outcome is the diagnostic accuracy of the TWIST score to rule out testicular torsion in low-risk patients, with secondary analyses of high-risk detection, time to surgery, and pain outcomes.
Why it matters
Potential benefit: If the TWIST score performs well in adults, it could let clinicians identify low-risk patients more quickly, reduce unnecessary imaging and delays, and help prioritize timely surgery for high-risk cases.
How similar studies have gone: The TWIST score has been validated with good performance in pediatric cohorts, but adult validation is limited and large multicenter adult data in Sweden are lacking.
Who can join: the full rules
Show full inclusion / exclusion 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)
Where it's running
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Linköping University Hospital, ED
Linköping, Östergötland County, Sweden Recruiting
Study contacts
- Principal investigator: Jens Wretborn, MD, PhD — Linkoeping University Hospital
- Study coordinator: Jens Wretborn, MD, PhD
- Email: jens.wretborn@liu.se
- Phone: +461030000
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How to take part
- Review the eligibility criteria above with your treating physician.
- Check the official listing on ClinicalTrials.gov for the latest contact details and recruitment status.
- Contact the study coordinator or principal investigator to ask for pre-screening. Pre-screening is free and never obligates you to enroll.