The  name of the article is prospective Validation of Clinical Score for Males Presenting With an Acute Scrotum published in academic emergency medicine. The objective was to validate the Testicular Workup for Ischemia and Suspected Torsion (TWIST) score among pediatric emergency medicine providers for the evaluation of pediatric males presenting with testicular pain and swelling (acute scrotum). The study was a prospective cohort study of males 3 months to 18 years old presenting with an acute scrotum.  In total 258 patients were enrolled in the study. Patients were excluded if their pain was due to a trauma, symptoms were present for greater than 1 week, there was a previous diagnosis of testicular torsion or a known history of testicular disease and/or surgery or if a diagnosis of testicular torsion had already been confirmed or excluded. Components of the TWIST score (hard testicle, absent cremasteric reflex, nausea/vomiting, and high riding testicle and each patient could get a score from 0 -7. The TWIST score is based on the sum (ranging from 0 to 7) : testicular swelling (2 points), hard testicle (2 points), absent cremasteric reflex (1 point), nausea or vomiting (1 point), and high riding testicle (1 point). The risk stratifying scores for those at low risk for testicular torsion were 0 to 2 points, intermediate risk were 3 to 4 points, and high risk for testicular torsion were 5 to 7 points. The primary outcome was a diagnosis of testicular torsion, confirmed by surgical exploration as the final diagnosis. 19/258 patients were diagnosed with TT with an ultrasound and 3 were after surgical exploration. The Ultrasound did  not demonstrate lack of vascular flow. Males with testicular torsion had higher mean TWIST scores than those with other testicular diagnoses. However, TWIST 0 to 1 – 2 patients diagnosed  with rotation When considering the final surgical diagnosis of testicular torsion, the TWIST score of 7 had 100% specificity and100% PPV for torsion, which is superior to clinical opinion. Based on these results, the Testicular Workup for Ischemia and Suspected Torsion score may be used as part of the decision making in the evaluation the acute scrotum, particularly for those with a score of 7 where emergent urology or surgical consultation would be recommended.