Value of TWIST score in the diagnosis of testicular torsion and the prediction of testicular retention in different populations: a multicenter retrospective analysis
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摘要: 目的 探讨TWIST评分对不同人群睾丸扭转诊断及扭转后睾丸能否保留的预测价值。方法 回顾性分析2016年1月—2021年4月安徽省合肥市4家三甲医院收治的睾丸扭转患者的临床资料，根据纳入和排除标准，纳入184例，均为手术探查确诊。患者年龄中值为15岁。根据年龄将其分为青春期前组(A组)、青春期组(B)和成人组(C组)，比较各组发病病程、入院是否为首诊医院、首诊至手术时间、扭转侧别、扭转程度、睾丸切除率及TWIST评分的差异。结果 A、B、C组年龄中值分别为5岁、14岁、21岁，3组发病病程、入院是否为首诊医院、首诊至手术时间、扭转侧别、扭转程度、睾丸切除率均差异无统计学意义。各组TWIST评分均为中高值(3~6分)，其中A组与B、C组间均差异具有统计学意义(均P < 0.05)，B组与C组间差异无统计学意义。单因素logistic回归分析显示，发病病程、睾丸扭转程度、非首诊医院及TWIST评分是睾丸保留的可能危险因素(均P < 0.05)；但多因素logistic回归分析显示仅发病病程、睾丸扭转程度、非首诊医院是睾丸能否保留的独立危险因素。结论 TWIST评分在不同人群睾丸扭转诊断中的阴性预测值为100%，不同人群均可使用该评分进行诊断，尤其是青春期前儿童。该评分系统操作简易，对于中高危患者甚至可以不行超声检查直接进行手术探查，减少医院间转诊，缩短睾丸缺血时间。对于睾丸能否保留，TWIST评分可能具有一定的预测价值，但需要结合发病病程、睾丸扭转程度及是否为首诊医院等因素综合评估。Abstract: Objective To investigate the predictive value of TWIST score in testicular torsion diagnosis and testicular retention in different populations.Methods Clinical data of TT patients admitted to 4 hospitals of Grade 3, Class A in Hefei city, Anhui Province from January 2016 to April 2021 were retrospectively analyzed. According to inclusion and exclusion criteria, 184 patients were included, all of whom were confirmed by surgical exploration. The median age of patients was 15 years old. All patients were divided into preadolescent group (group A), adolescent group (group B) and adult group (group C) according to their age. The differences in time of onset, whether the hospital was the first hospital to visit, the time of visit to surgery, intraoperative testicular torsion sides, degrees, testicular retention and TWIST score were compared among each group.Results The median age were 5, 14, 21 years old in group A, B and C respectively. There were no statistically significant differences in time of onset, whether the hospital was the first hospital to visit, the time of visit to surgery, intraoperative testicular torsion sides, degrees, testicular retention among the three groups. The TWIST scores in three groups were medium and high (3-6 points), and the differences between group A and group B, C were statistically significant (both P < 0.05). But there was no significant difference between group B and group C. Univariate logistic regression analysis showed that the time of onset, the degrees of testicular torsion, the hospital which was not the first hospital to visit, and TWIST score were possible risk factors for testicular retention (all P < 0.05). However, multivariate logistic regression analysis showed that only the time of onset, testicular torsion degrees and the non-first hospital for visit were independent risk factors for testicular retention.Conclusion TWIST score has a negative predictive value of 100% in testicular torsion diagnosis among different populations. TWIST score can be used for testicular torsion diagnosis in different populations, especially in prepubertal children. The scoring system is easy to operate. Surgical exploration can be performed for medium and high risk patients even without ultrasound examination so as to reduce inter-hospital referral and shorten testicular ischemia time. The TWIST score also has predictive value for testicular retention. but it needs to be considered in combination with the time of onset, degrees of testicular torsion and whether the hospital was the first hospital to visit.
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Key words:
- testicular torsion /
- age distribution /
- physical examination /
- diagnosis
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表 1 患者社会人口学特征及临床特征
M(P25，P75) 指标 数值 年龄/岁 15(13，19) 发病病程/h 48(7，72) 首诊至手术时间/h 2.0(1.5~3.0) 扭转程度/° 360(270，540) 睾丸切除/例(%) 127(69.0) 首诊医院/例(%) 107(58.2) TWIST评分 5(4，6) 
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表 2 A、B、C组患者临床特征
M(P25，P75) 指标 A组(33例) B组(91例) C组(60例) P 年龄/岁 5(2，11) 14(13，15) 21(19，25) < 0.001 发病病程/h 48(24，90) 48(8，78) 24(5.25，72.00) 0.450 首诊至手术时间/h 2.00(1.25，3.00) 2.00(1.50，3.00) 2.25(1.63，4.00) 0.085 扭转程度/° 360(315，720) 360(337，540) 360(270，630) 0.840 睾丸切除/例(%) 23(69.7) 68(74.7) 36(60.0) 0.160 首诊医院/例(%) 18(54.5) 51(56.0) 38(63.3) 0.610 TWIST评分 6.00(5.00，6.00) 5.00(5.00，6.00) 5.00(3.25，6.00) 0.019
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表 3 单因素logistic回归分析
指标 截距 B P 95%CI 年龄 -0.92 0.01 0.600 0.977~1.042 发病病程 0.49 -0.03 < 0.001 0.954~0.980 首诊至手术时间 -0.83 0.02 0.520 0.96~1.08 扭转程度 1.12 -0.005 < 0.001 0.993~0.997 首诊医院 -1.81 1.57 < 0.001 2.28~10.06 TWIST 0.78 -0.33 0.020 0.55~0.95
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表 4 多因素logistic回归分析
指标 β OR(95%CI) P 截距 1.56 发病病程 -0.032 0.97(0.950~0.980) < 0.001 扭转程度 -0.006 0.99(0.992~0.997) < 0.001 首诊医院 1.10 3.00(1.130~7.960) 0.03 TWIST 0.04 1.04(0.730~1.480) 0.84
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表 5 发病病程、首诊医院、扭转程度对睾丸保留的预测效能
指标 AUC(95%CI) 截断值 灵敏度/% 特异度/% 发病病程 0.852(0.788~0.916) 19.25 h 84.9 80 首诊医院 0.671(0.589~0.753) 扭转程度 0.754(0.675~0.832) 315° 85.7 54.5
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