MP40-05 DOES NEAR INFRARED SPECTROSCOPY IMPROVE TWIST SCORE IN THE DIAGNOSIS OF TESTICULAR TORSION?

You have accessJournal of UrologyPediatrics: Testis & Varicoceles, Stones1 Apr 2015MP40-05 DOES NEAR INFRARED SPECTROSCOPY IMPROVE TWIST SCORE IN THE DIAGNOSIS OF TESTICULAR TORSION? Kunj R. Sheth, Melise Keays, Gwen Grimsby, Candice Granbery, Daniel G. DaJusta, Lauren Ostrov, Martinez Hill, Emma Sanchez, Clanton Harrison, Micah Jacobs, Rong Huang, Berk Burgu, Halim Hennes, Bruce Schlomer, and L.A. Baker Kunj R. ShethKunj R. Sheth More articles by this author , Melise KeaysMelise Keays More articles by this author , Gwen GrimsbyGwen Grimsby More articles by this author , Candice GranberyCandice Granbery More articles by this author , Daniel G. DaJustaDaniel G. DaJusta More articles by this author , Lauren OstrovLauren Ostrov More articles by this author , Martinez HillMartinez Hill More articles by this author , Emma SanchezEmma Sanchez More articles by this author , Clanton HarrisonClanton Harrison More articles by this author , Micah JacobsMicah Jacobs More articles by this author , Rong HuangRong Huang More articles by this author , Berk BurguBerk Burgu More articles by this author , Halim HennesHalim Hennes More articles by this author , Bruce SchlomerBruce Schlomer More articles by this author , and L.A. BakerL.A. Baker More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1187AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The TWIST (Testicular Workup for Ischemia and Suspected Torsion) score by Barbosa et al. uses history and physical exam to diagnose testis torsion. Trans-scrotal near infrared spectroscopy (NIRS) is a rapid test reported to diagnose testis torsion. This study assessed the TWIST score for diagnosis of torsion in a prospective pediatric cohort and to test hypothesis that NIRS improves TWIST score performance. METHODS Children >2 months and <18 years old with acute scrotum were enrolled in a NIH funded prospective study evaluating NIRS as a diagnostic test for testis torsion. Patients underwent a history and physical examination which included the TWIST score paremeters – testis swelling (2 points), hard testis (2), absent cremasteric reflex (1), nausea/vomiting (1), and high riding testis (1). Testicular tissue saturation of oxygen (StO2) measurements obtained by NIRS on affected and normal testes were obtained. A diagnosis of torsion was made by history, physical exam, or ultrasound and confirmed at surgical exploration. Receiver operating characteristic (ROC) curves were used to analyze TWIST score and addition of NIRS to TWIST score as a diagnostic test for torsion. RESULTS Of 128 patients with attempted NIRS readings, 116 had TWIST data. TWIST score ROC curve had an AUC of 0.97 (95% CI: 0.91-0.99). Interval cutoffs of 2 and 6 were chosen: 62/64 with TWIST score ≤ 2 did not have torsion (NPV 96.9%), scores of 3-5 were equivocal with 7/24 (29.2%) with torsion, 26/28 with a score ≥ 6 had torsion for a PPV of 92.9%. NIRS StO2 readings that were ≥ 20 points lower on the affected testis had a PPV of 100% and a sensitivity of 23% for diagnosing testis torsion. 2 points were added to TWIST score if NIRS StO2 reading was ≥ 20 points lower in affected testis. The ROC curve for addition of NIRS to TWIST score had an AUC of 0.96 (95% CI 0.92-0.99). Two patients who had indeterminate (3-5) TWIST scores became high risk (≥6) with use of NIRS. CONCLUSIONS The TWIST score performed well in this prospective study. In contrast to prior studies, the optimal cut-off values were 2 and 6 for low and high risk and 2 patients with a score ≤2 had torsion. Patients with high risk TWIST score should go to surgery without delay for ultrasound. For those with low or intermediate TWIST scores, current NIRS technology may detect some additional torsion cases to obviate need for ultrasound but cannot be used alone to rule out torsion. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byQin K and Qu L (2022) Diagnosing with a TWIST: Systematic Review and Meta-Analysis of a Testicular Torsion Risk ScoreJournal of Urology, VOL. 208, NO. 1, (62-70), Online publication date: 1-Jul-2022. Volume 193Issue 4SApril 2015Page: e464 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kunj R. Sheth More articles by this author Melise Keays More articles by this author Gwen Grimsby More articles by this author Candice Granbery More articles by this author Daniel G. DaJusta More articles by this author Lauren Ostrov More articles by this author Martinez Hill More articles by this author Emma Sanchez More articles by this author Clanton Harrison More articles by this author Micah Jacobs More articles by this author Rong Huang More articles by this author Berk Burgu More articles by this author Halim Hennes More articles by this author Bruce Schlomer More articles by this author L.A. Baker More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...