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 - A Prospective Observational Study

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Conditions studied: Testicular Torsion, Acute Scrotum, Scrotal Pain

In brief

This prospective multicenter observational study aims to evaluate the diagnostic accuracy of the Testicular Workup for Ischemia and Suspected Torsion (TWIST) score in adult patients presenting with acute scrotal pain in Swedish Emergency Departments. The TWIST score is a clinical decision tool originally validated in pediatric populations to stratify patients into low, intermediate, and high risk for testicular torsion. The study will include men aged 18-40 years presenting with scrotal pain or symptoms suggestive of torsion. Patients with scrotal trauma, symptom duration over one week, previous testicular surgery, or inability to give informed consent in Swedish will be excluded. Participants' clinical findings will be recorded on a standardized form, and the TWIST score will be calculated. Management will follow standard clinical practice independently of the study. Primary outcome is the diagnostic accuracy of the TWIST score to rule out testicular torsion in low-risk patients (TWIST 0-2). Secondary outcomes include diagnosis of torsion within 30 days, time to surgery, patient-reported pain, number of Doppler ultrasounds performed, and the potential reduction in unnecessary imaging. The study will be conducted at multiple Swedish sites, including Linköping University Hospital, under oversight by the Swedish Ethical Review Authority (Etikprövningsmyndigheten, decision number 2025-07400-01). The results aim to inform clinical practice by providing a validated decision-support tool for adult patients with suspected testicular torsion, potentially improving patient outcomes and resource utilization.

Key facts

Study ID

NCT07499024

Run by

University Hospital, Linkoeping

People needed

1000

Starts

2026-02-01

Expected to finish

2029-12-31

Last updated by the study team

2026-04-29

Who can join

Age: 18 and older, up to 40. Sex: male. Healthy volunteers: not accepted.

You may qualify if…

• 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

You may not qualify if…

• 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 is running

• Linköping University Hospital, ED — Linköping, Östergötland County, Sweden (enrolling)

Full record on ClinicalTrials.gov

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