{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T10:13:51Z","timestamp":1786702431492,"version":"build-2736575974"},"reference-count":26,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2017,10,16]],"date-time":"2017-10-16T00:00:00Z","timestamp":1508112000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Academic Emergency Medicine"],"published-print":{"date-parts":[[2017,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>The objective was to validate the Testicular Workup for Ischemia and Suspected Torsion (<jats:styled-content style=\"fixed-case\">TWIST<\/jats:styled-content>) score among pediatric emergency medicine providers for the evaluation of pediatric males presenting with testicular pain and swelling (acute scrotum).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted a prospective cohort study of males 3 months to 18 years old presenting with an acute scrotum. History and physical examination findings, including components of the <jats:styled-content style=\"fixed-case\">TWIST<\/jats:styled-content> score (hard testicle, absent cremasteric reflex, nausea\/vomiting, and high riding testicle) as well as diagnostic results (ultrasound, urine, sexually transmitted infection testing) were recorded. Testicular torsion was confirmed by surgical exploration. Frequencies of patient characteristics, <jats:styled-content style=\"fixed-case\">TWIST<\/jats:styled-content> components, and tests were calculated. We performed the kappa statistic for inter\u2010rater reliability and calculated the test characteristics and receiver operator characteristics curves for the <jats:styled-content style=\"fixed-case\">TWIST<\/jats:styled-content> score (range = 0\u20137).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>During the study period 258 males were enrolled in the study; 19 (7.4%) had testicular torsion. The mean (\u00b1<jats:styled-content style=\"fixed-case\">SD<\/jats:styled-content>) age was 9.8 (\u00b10.3) years. The high\u2010risk <jats:styled-content style=\"fixed-case\">TWIST<\/jats:styled-content> score of 7 had 100% specificity (95% confidence interval [<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>] = 98%\u2013100%) with 100% positive predictive value (95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> = 40%\u2013100%) for testicular torsion. The area under the curve was 0.82. The kappa statistic for the overall <jats:styled-content style=\"fixed-case\">TWIST<\/jats:styled-content> score was fair at 0.39.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In this prospective validation of the <jats:styled-content style=\"fixed-case\">TWIST<\/jats:styled-content> score among pediatric emergency providers, the high\u2010risk score demonstrated strong test characteristics for testicular torsion. The <jats:styled-content style=\"fixed-case\">TWIST<\/jats:styled-content> score could be used as part of a standardized approach for evaluation of the pediatric acute scrotum to provide more efficient and effective care.<\/jats:p><\/jats:sec>","DOI":"10.1111\/acem.13295","type":"journal-article","created":{"date-parts":[[2017,8,20]],"date-time":"2017-08-20T11:22:37Z","timestamp":1503228157000},"page":"1474-1482","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":50,"title":["Prospective Validation of Clinical Score for Males Presenting With an Acute Scrotum"],"prefix":"10.1111","volume":"24","author":[{"given":"Lillian C.","family":"Frohlich","sequence":"first","affiliation":[{"name":"Bioverativ, Waltham MA"},{"name":"Division of Emergency Medicine Boston Children's Hospital Boston 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