Simple Scoring System Could Predict Adnexal Torsion

MIAMI BEACH – A scoring system based on three factors identified in a study could aid your decision whether to proceed with surgery for girls with suspected adnexal torsion, results of a small study suggest.

Adnexal torsion is often part of the differential diagnosis of girls who present to an emergency department with abdominal or pelvic pain. An accurate diagnosis of torsion and swift surgical intervention can be important to preclude serious reproductive consequences including loss of an ovary or adnexa.

Dr. Samantha E. Montgomery and her colleagues prospectively studied 32 girls who underwent surgery for suspected adnexal torsion. They compared 16 cases with confirmed torsion (13 ovarian, 2 tubal, and 1 paratubal) with 16 controls with other adnexal findings.

They looked for significant predictors based on patient presentation. "No single factor was significant alone, so we developed a composite score," Dr. Montgomery said at the annual meeting of the North American Society for Pediatric and Adolescent Gynecology.

A score of 0 to 6 is possible based on premenarchal status (yes = 2, no = 0); presence of nausea and/or vomiting (nausea = 1, vomiting = 2, none = 0); and adnexal volume (20 mL or less = 0, 21 mL to 70 mL = 1, greater than 70 mL = 2).

There were six girls who scored a 0 or 1 and none were diagnosed with torsion, for 100% specificity. A score of 4 or more correctly identified 12 out of 14 girls with torsion, for 75% sensitivity and 86% specificity. A score of 2 or 3 was less definitive; this group included four girls with torsion and eight girls without this condition. Patients who score 2 or 3 should be considered for surgery, said Dr. Montgomery, a pediatric and adolescent gynecology fellow at the University of Cincinnati and Cincinnati Children’s Hospital.

Doppler flow, duration of pain, affected volume in mL, and adnexal ratio were not significantly associated with torsion in the study.

The cross-sectional study included patients 6-21 years of age with abdominal or pelvic pain. They each presented to the emergency department at Cincinnati Children’s Hospital Medical Center between August 2007 and August 2009.

Strengths of the study include its prospective design and inclusion of prepubertal patients, Dr. Montgomery said. Limitations include a small sample size and an inability to distinguish ovarian from isolated tubal torsion so all cases were termed "adnexal torsion."

The composite score has not yet been validated, Dr. Montgomery said in response to a meeting attendee question.

Radiologic assessment was standardized in a sequential protocol that started with right lower quadrant ultrasound followed by pelvic ultrasound. If the appendix could not be visualized at this point, an abdominal/pelvic CT scan could be ordered as well.

A future aim is to assess a larger sample of premenarchal girls, Dr. Montgomery said.

Dr. Montgomery said she had no relevant financial disclosures.

MIAMI BEACH – A scoring system based on three factors identified in a study could aid your decision whether to proceed with surgery for girls with suspected adnexal torsion, results of a small study suggest.

Adnexal torsion is often part of the differential diagnosis of girls who present to an emergency department with abdominal or pelvic pain. An accurate diagnosis of torsion and swift surgical intervention can be important to preclude serious reproductive consequences including loss of an ovary or adnexa.

Dr. Samantha E. Montgomery and her colleagues prospectively studied 32 girls who underwent surgery for suspected adnexal torsion. They compared 16 cases with confirmed torsion (13 ovarian, 2 tubal, and 1 paratubal) with 16 controls with other adnexal findings.

They looked for significant predictors based on patient presentation. "No single factor was significant alone, so we developed a composite score," Dr. Montgomery said at the annual meeting of the North American Society for Pediatric and Adolescent Gynecology.

A score of 0 to 6 is possible based on premenarchal status (yes = 2, no = 0); presence of nausea and/or vomiting (nausea = 1, vomiting = 2, none = 0); and adnexal volume (20 mL or less = 0, 21 mL to 70 mL = 1, greater than 70 mL = 2).

There were six girls who scored a 0 or 1 and none were diagnosed with torsion, for 100% specificity. A score of 4 or more correctly identified 12 out of 14 girls with torsion, for 75% sensitivity and 86% specificity. A score of 2 or 3 was less definitive; this group included four girls with torsion and eight girls without this condition. Patients who score 2 or 3 should be considered for surgery, said Dr. Montgomery, a pediatric and adolescent gynecology fellow at the University of Cincinnati and Cincinnati Children’s Hospital.

Doppler flow, duration of pain, affected volume in mL, and adnexal ratio were not significantly associated with torsion in the study.

The cross-sectional study included patients 6-21 years of age with abdominal or pelvic pain. They each presented to the emergency department at Cincinnati Children’s Hospital Medical Center between August 2007 and August 2009.

Strengths of the study include its prospective design and inclusion of prepubertal patients, Dr. Montgomery said. Limitations include a small sample size and an inability to distinguish ovarian from isolated tubal torsion so all cases were termed "adnexal torsion."

The composite score has not yet been validated, Dr. Montgomery said in response to a meeting attendee question.

Radiologic assessment was standardized in a sequential protocol that started with right lower quadrant ultrasound followed by pelvic ultrasound. If the appendix could not be visualized at this point, an abdominal/pelvic CT scan could be ordered as well.

A future aim is to assess a larger sample of premenarchal girls, Dr. Montgomery said.

Dr. Montgomery said she had no relevant financial disclosures.

MIAMI BEACH – A scoring system based on three factors identified in a study could aid your decision whether to proceed with surgery for girls with suspected adnexal torsion, results of a small study suggest.

Adnexal torsion is often part of the differential diagnosis of girls who present to an emergency department with abdominal or pelvic pain. An accurate diagnosis of torsion and swift surgical intervention can be important to preclude serious reproductive consequences including loss of an ovary or adnexa.

Dr. Samantha E. Montgomery and her colleagues prospectively studied 32 girls who underwent surgery for suspected adnexal torsion. They compared 16 cases with confirmed torsion (13 ovarian, 2 tubal, and 1 paratubal) with 16 controls with other adnexal findings.

They looked for significant predictors based on patient presentation. "No single factor was significant alone, so we developed a composite score," Dr. Montgomery said at the annual meeting of the North American Society for Pediatric and Adolescent Gynecology.

A score of 0 to 6 is possible based on premenarchal status (yes = 2, no = 0); presence of nausea and/or vomiting (nausea = 1, vomiting = 2, none = 0); and adnexal volume (20 mL or less = 0, 21 mL to 70 mL = 1, greater than 70 mL = 2).

There were six girls who scored a 0 or 1 and none were diagnosed with torsion, for 100% specificity. A score of 4 or more correctly identified 12 out of 14 girls with torsion, for 75% sensitivity and 86% specificity. A score of 2 or 3 was less definitive; this group included four girls with torsion and eight girls without this condition. Patients who score 2 or 3 should be considered for surgery, said Dr. Montgomery, a pediatric and adolescent gynecology fellow at the University of Cincinnati and Cincinnati Children’s Hospital.

Doppler flow, duration of pain, affected volume in mL, and adnexal ratio were not significantly associated with torsion in the study.

The cross-sectional study included patients 6-21 years of age with abdominal or pelvic pain. They each presented to the emergency department at Cincinnati Children’s Hospital Medical Center between August 2007 and August 2009.

Strengths of the study include its prospective design and inclusion of prepubertal patients, Dr. Montgomery said. Limitations include a small sample size and an inability to distinguish ovarian from isolated tubal torsion so all cases were termed "adnexal torsion."

The composite score has not yet been validated, Dr. Montgomery said in response to a meeting attendee question.

Radiologic assessment was standardized in a sequential protocol that started with right lower quadrant ultrasound followed by pelvic ultrasound. If the appendix could not be visualized at this point, an abdominal/pelvic CT scan could be ordered as well.

A future aim is to assess a larger sample of premenarchal girls, Dr. Montgomery said.

Dr. Montgomery said she had no relevant financial disclosures.