Testicular torsion Point-based Assessment and Imaging tool - identifying Need for Surgical exploration (TPAINS): a clinical algorithm for detecting testicular torsion.

OBJECTIVE Testicular torsion (TT) is a medical emergency, difficult to identify solely through clinical evaluation. This study aims to develop an assessment algorithm with a safe lower threshold for complementary ultrasound.

MATERIAL AND METHODS Males between 1 and 30 years of age assessed for suspected TT during the years 2019 - 2023 were retrospectively included. Clinical assessments were conducted by primarily nonurologists and ultrasounds by radiologists. An assessment algorithm named Testicular torsion Point-based Assessment and Imaging tool - identifying Need for Surgical exploration (TPAINS) was developed based on symptoms showing significant correlation with TT.

RESULTS Of the 417 patients included, 68 (16%) were surgically explored and 33 (8%) diagnosed with TT. Six symptoms showing a significant association with TT were combined for the development of the algorithm TPAINS. With a cut-off value of ≥2 points, TPAINS showed a sensitivity of 100% (confidence interval, CI: [90, 100]), specificity 54% (CI [49 - 59]), and an AUC-value of 0.89 (95% CI [84 - 94]).

CONCLUSIONS This study concludes that symptom-based evaluation, together with a low threshold for ultrasound, is a promising approach for the detection of TT. The developed algorithm, TPAINS, includes an ultrasound assessment and focuses on safe lower thresholds for further clinical actions - hoping for a reduced rate of unnecessary surgical explorations.