Can the Testicular Workup for Ischemia and Suspected Torsion score risk stratify pediatric males with acute scrotum?

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Why is this study important?

Testicular torsion is a time-sensitive complaint requiring rapid identification and management, ideally within 6 hours for highest likelihood of testicular salvage. [1] This study assesses the validity of the Testicular Workup for Ischemia and Suspected Torsion (TWIST) score applied by pediatric emergency physicians to help differentiate from other testicular pathology such as epididymitis or trauma using the following signs: testicular swelling (2 points), hard testicle (2 points), absent cremasteric reflex (1 point), nausea or vomiting (1 point), and high-riding testicle (1 point).

Which, if any, threats to validity are most likely to have an impact on the results and how?

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