How well the TWIST score predicts testicular torsion in adults with sudden scrotal pain
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
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 |
|---|---|
| Enrollment | 1000 (estimated) |
| Ages | 18 Years to 40 Years |
| Sex | Male |
| Sponsor | University Hospital, Linkoeping Academic / other |
| Locations | 1 site (Linköping, Östergötland County) |
| Trial ID | NCT07499024 on ClinicalTrials.gov |
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.
Who should consider this trial
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.
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.
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 performed: 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.
Eligibility criteria
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 this trial is running
Linköping, Östergötland County
- 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
How to participate
- Review the eligibility criteria above with your treating physician.
- Visit the official trial page on ClinicalTrials.gov for the most current contact information and recruitment status.
- Contact the listed study coordinator or principal investigator to request pre-screening. Pre-screening is free and never obligates you to enroll.