twist_score: Testicular Workup for Ischemia and Suspected Torsion (TWIST)...

In cliot: Clinical Indices and Outcomes Tools

Testicular Workup for Ischemia and Suspected Torsion (TWIST) Score

Description

Calculates the TWIST Score to stratify the risk of testicular torsion in male patients presenting with acute scrotal pain. The score helps identify patients who may require immediate surgical exploration versus those who can be safely managed with ultrasound or clinical observation.

Usage

twist_score(testicular_swelling, hard_testicle, absent_cremasteric_reflex,
            nausea_vomiting, high_riding_testicle)

Arguments

testicular_swelling	Numeric (0 or 1). Presence of testicular swelling. (1 = Yes, +2 points).
hard_testicle	Numeric (0 or 1). Presence of a hard testicle on palpation. (1 = Yes, +2 points).
absent_cremasteric_reflex	Numeric (0 or 1). Absence of the cremasteric reflex. (1 = Yes, +1 point).
nausea_vomiting	Numeric (0 or 1). Nausea or vomiting. (1 = Yes, +1 point).
high_riding_testicle	Numeric (0 or 1). High-riding testicle. (1 = Yes, +1 point).

Value

A list containing:

TWIST_Score	The calculated total score (Range 0-7).
Risk_Category	Classification (Low: 0-2, Intermediate: 3-4, High: 5-7).
Recommendation	Clinical guidance regarding imaging and consultation.

References

Barbosa JA, Tiseo BC, Barayan GA, et al. Development and initial validation of a scoring system to diagnose testicular torsion in children. J Urol. 2013;189(5):1859-1864. doi:10.1016/j.juro.2012.10.056

Examples

# Example 1: High Risk
# Swelling (1), Hard (1), No Reflex (1), Nausea (0), High Riding (0)
# Score = 2 + 2 + 1 = 5
twist_score(1, 1, 1, 0, 0)

# Example 2: Low Risk
# No swelling, soft testicle, reflex present (0), nausea (1), normal position
# Score = 1
twist_score(0, 0, 0, 1, 0)

cliot documentation built on Dec. 1, 2025, 1:06 a.m.