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The utility of a composite index for the evaluation of ovarian torsion
Alice King1, Sundeep Keswani1, Jacek Biesiada2
1Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States.
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.
