Testicular torsion Point-based Assessment and Imaging tool-identifying Need for Surgical exploration (TPAINS) : a clinical algorithm for detecting testicular torsion
Dahlgren, Nathalie ; Sundström, Gustav LU ; Nilsson, Charlotta LU and Wagenius, Magnus LU
(2026)
In Scandinavian Journal of Urology
61.
p.92-98
- Abstract
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... (More)
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.
(Less)
- author
- Dahlgren, Nathalie
; Sundström, Gustav
LU
; Nilsson, Charlotta
LU
and Wagenius, Magnus
LU
- organization
- publishing date
- 2026
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- assessment algorithm, spermatic cord torsion, Testicular torsion, TWIST score, ultrasound
- in
- Scandinavian Journal of Urology
- volume
- 61
- pages
- 7 pages
- publisher
- Taylor & Francis
- external identifiers
-
- scopus:105034704325
- pmid:41906723
- ISSN
- 2168-1805
- DOI
- 10.2340/sju.v61.45578
- language
- English
- LU publication?
- yes
- additional info
- Publisher Copyright: © 2026 The Author(s).
- id
- 92b2e7b6-7e0b-4bb5-8932-ef274279c551
- date added to LUP
- 2026-05-25 14:35:05
- date last changed
- 2026-05-26 06:21:54
@article{92b2e7b6-7e0b-4bb5-8932-ef274279c551,
abstract = {{<p>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.</p>}},
author = {{Dahlgren, Nathalie and Sundström, Gustav and Nilsson, Charlotta and Wagenius, Magnus}},
issn = {{2168-1805}},
keywords = {{assessment algorithm; spermatic cord torsion; Testicular torsion; TWIST score; ultrasound}},
language = {{eng}},
pages = {{92--98}},
publisher = {{Taylor & Francis}},
series = {{Scandinavian Journal of Urology}},
title = {{Testicular torsion Point-based Assessment and Imaging tool-identifying Need for Surgical exploration (TPAINS) : a clinical algorithm for detecting testicular torsion}},
url = {{http://dx.doi.org/10.2340/sju.v61.45578}},
doi = {{10.2340/sju.v61.45578}},
volume = {{61}},
year = {{2026}},
}