Comparison of Testicular Workup for Ischemia and Suspected Torsion (TWIST), Testicular Torsion (TT Lim), and Boettcher Alert (BAL) Scoring Systems for the Diagnosis of Testicular Torsion in 50 Surgical Cases.

Objective The objective of the study was to compare the diagnostic accuracy of three clinical scoring systems (Testicular Workup for Ischemia and Suspected Torsion (TWIST), Testicular Torsion Lim (TT developed by Lim), and Boettcher Alert (BAL) scoring systems) for testicular torsion (TT) in patients presenting with acute scrotum. Methods This retrospective study included 50 patients who underwent emergency scrotal exploration at the Saga University Hospital between January 2010 and December 2023. The TWIST, TT (Lim), and BAL scores were calculated from medical records, and their diagnostic performance was assessed using sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). The study protocol was approved by the Institutional Review Board of Saga University. Results Out of 50 patients, 34 (68%) were diagnosed with TT. The TWIST score showed 88.2% sensitivity, 43.8% specificity, 90.9% PPV, and 87.5% NPV. The TT (Lim) score demonstrated 85.3% sensitivity, 18.8% specificity, 96.7% PPV, and 100% NPV. The BAL score showed the highest sensitivity (94.1%) but lower specificity (37.5%), with a PPV of 76.2% and an NPV of 75.0%. All scores showed statistically significant associations with the TT diagnosis (p<0.01). Conclusions The TWIST, TT (Lim), and BAL scores have unique advantages in evaluating an acute scrotum. BAL may be most suitable for initial screening because of its high sensitivity, whereas TWIST may aid surgical decision-making. The TT score may be useful in ruling out torsion in selected low-risk cases, although validation in larger cohorts is required.