Akademik Veri Yönetim Sistemi
Journal of Pediatric Urology, cilt.22, sa.2, 2026 (SCI-Expanded, Scopus)
Objective To evaluate the diagnostic accuracy of the Testicular Workup for Ischemia and Suspected Torsion (TWIST) score in children presenting with acute scrotum and to assess its impact on clinical and surgical outcomes. Methods We retrospectively reviewed 324 pediatric patients admitted with acute scrotum between March 2020 and February 2025. Patients were divided into two groups: those evaluated before TWIST implementation (pre-TWIST, n = 178) and after (post-TWIST, n = 146). Demographic, clinical, laboratory, radiological, operative, and follow-up data were collected. The diagnostic performance of the TWIST score was assessed using receiver operating characteristic (ROC) analysis. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and likelihood ratios were calculated for a cut-off score of ≥6. Results The median age and symptom duration did not differ significantly between groups. The proportion of patients undergoing scrotal exploration decreased significantly after TWIST implementation (56.2 % vs. 36.5 %, p < 0.001). Among operated patients, the median time from admission to surgery was shorter post-TWIST (0.75 h vs. 2 h, p < 0.001). Negative exploration rates fell significantly (51.0 % vs. 7.5 %, p < 0.001), and detorsion/fixation procedures significantly increased (77.3 % vs. 42.0 %, p < 0.001), without significant change in orchiectomy rates (7 % vs. 15 %, p = 0.109). Testicular atrophy following detorsion occurred in 9 % and 7.5 % of patients in the pre- and post-TWIST groups, respectively ( p = 0.759). Diagnostic accuracy analysis showed an AUC of 0.94 (95 % CI: 0.91–0.98, p < 0.001). At a cut-off ≥6, sensitivity was 73.5 % and specificity was 96.9 %, with PPV 92.3 %, NPV 87.9 %, LR+ 23.7, and LR– 0.27. Conclusions Implementation of the TWIST score improved the management of pediatric acute scrotum by reducing unnecessary explorations and surgical delays while maintaining high diagnostic accuracy for testicular torsion. A cut-off of ≥6 provides strong rule-in value, whereas low scores reliably exclude torsion, supporting TWIST as a practical decision-making tool in the acute setting.