Use of TWIST Score and BAL Score in Diagnosing Testicular Torsion in Children with Acute Scrotum: A Retrospective Study

Introduction: Early diagnosis and management of Torsion Testis (TT) in children is challenging. To improve the reliability of diagnosis, various clinical scoring systems have been proposed. Testicular Workup for Ischaemia and Suspected Torsion (TWIST) score and Boettcher Alert (BAL) score have been used for the diagnosis of TT in children with acute scrotum. Aim: To find the utility of TWIST and BAL score for diagnosing testicular torsion in children with acute scrotum. Materials and Methods: This was a retrospective record-based study that included medical records of children with acute scrotum who underwent surgery between January 2019 and December 2021 in a tertiary care hospital. A total of 112 patients were included in the study. TWIST and BAL scores were calculated, retrospectively. Univariate analysis of the clinical features were done using Chi-square test. Sensitivity, specificity, Positive Predicitive Value (PPV) and Negative Predicitive Value (NPV) for scoring systems were calculated. Results: There were 73 patients in TT group and 39 in Non Torsion Testis (NTT) group. The mean age was 4.5 +/- 2.98 years in torsion group and 5.2 +/- 2.2 years in non torsion group. Among the components of TWIST and BAL score, absent cremasteric reflex, hard testicle, high riding testis, nausea/vomiting and pain duration <24 hours were found to be statistically significant. PPV and specificity of TWIST score >= 5 were 98.15% and 97.44%, respectively whereas NPV and sensitivity of BAL score >= 2 group was 100%. Conclusion: TWIST and BAL scores are reliable bedside and easy to perform clinical diagnostic tools for TT. These scores can help in early detection and plan surgical intervention to reduce ischaemia time of TT.