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Eur J Pediatr Surg 2014; 24(02): 136-140
DOI: 10.1055/s-0033-1343084
Original Article
Georg Thieme Verlag KG Stuttgart · New York

The Utility of a Composite Index for the Evaluation of Ovarian Torsion

Alice King
1   Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
,
Sundeep Keswani
1   Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
,
Jacek Biesiada
2   Division of Biomedical Informatics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
,
Lesley Breech
3   Division of Obstetrics and Gynecology, Pediatrics and Pediatric Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
,
Timothy Crombleholme
4   Division of Pediatric Surgery, Children's Hospital Colorado, Aurora, Colorado, United States
,
Jill Huppert
3   Division of Obstetrics and Gynecology, Pediatrics and Pediatric Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
› Author Affiliations
Further Information

Publication History

30 November 2012

13 February 2013

Publication Date:
15 April 2013 (online)

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Abstract

Background/Purpose Ovarian torsion (OT) is a clinical diagnosis with a variable presentation. The aim of this study was to develop a practical scoring system to predict patients with OT in the pediatric population to facilitate more accurate diagnosis.

Methods A retrospective study evaluating menarchal pediatric patients (1998 to 2005) with surgically confirmed OT (n = 28) compared with patients with abdominal pain and surgically confirmed non-OT (n = 26). Histogram analysis was performed to determine threshold values and used to generate the OT composite index (OT-CI).

Results Four factors were independently associated with OT: ovarian ratio, ovarian volume, nausea, and duration of pain. Arterial and venous Doppler flows were not associated with OT. The OT-CI was more accurate than any individual factor. There were no cases of OT in patients with OT-CI scores < 3. Patients with score ≥ 3 had 100% sensitivity and 65.3% specificity. A score ≥ 5 has 100% specificity.

Conclusions The OT-CI is a practical scoring system combining clinical and radiologic findings to more accurately predict OT. An OT-CI score < 3 is strong evidence against OT in pediatric menarchal patients, which may minimize unnecessary surgical intervention. In contrast, scores ≥ 3 should be considered for surgical intervention to maximize ovarian salvage.

Keywords

ovarian - torsion - scoring system
 

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