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Ovarian torsion in children: Development of a predictive score
Philipp Bolli1, Sabine Schädelin, Stefan Holland-Cunz
1Pediatric Surgery, University Children's Hospital Basel Clinical Trial Unit, University Hospital Basel, Basel, Switzerland Pediatric Surgery, University of Leipzig, Leipzig, Germany.
Insights
This study identified key symptoms like vomiting and short pain duration to predict ovarian torsion (OT) in children. A simple score was developed to aid in diagnosing this urgent condition, improving early detection and treatment.
Area of Science:
- Pediatric Surgery
- Gynecology
- Emergency Medicine
Background:
- Ovarian torsion (OT) is a gynecological emergency in children, often presenting with non-specific symptoms.
- Early and accurate diagnosis of OT is crucial to preserve ovarian function.
- Existing diagnostic tools may lack specificity in pediatric populations.
Purpose of the Study:
- To identify clinical signs and symptoms indicative of ovarian torsion in pediatric patients.
- To develop a simple, effective predictive score for diagnosing ovarian torsion in children.
- To improve the diagnostic accuracy and timeliness of ovarian torsion management.
Main Methods:
- Retrospective chart review of 80 pediatric patients with acute adnexal pathologies.
- Data collection included demographics, clinical symptoms, laboratory results, imaging, and treatment.
- Development of a predictive score based on age, vomiting, and pain duration.
Main Results:
- Ovarian torsion (OT) was diagnosed in 17% of cases; ovarian cysts (OC) in 79%.
- Patients with OT were significantly younger and less likely to have reached menarche.
- Vomiting, shorter pain duration, and elevated C-reactive protein (CRP) were significantly associated with OT.
Conclusions:
- Vomiting, short abdominal pain duration, and elevated CRP are valuable predictors of pediatric ovarian torsion.
- The developed ovarian torsion score demonstrates high sensitivity, particularly in younger children (2-12 years).
- Prompt exploratory laparoscopy is recommended for children with a high suspicion of ovarian torsion based on these clinical factors.
Abstract:
The aim of this study was to identify clinical signs and symptoms of ovarian torsion (OT) in children and to develop a simple predictive score.A chart review of patients with acute adnexal pathologies treated at the University Children's Hospital Basel, Switzerland, between March 2006 and June 2015 was performed. Medical records were screened for demographic and clinical data. These included clinical symptoms, laboratory studies, imaging, and type of treatment. The diagnosis OT was defined as intraoperative visualization of the torsed ovary around its pedicle at least 360 degrees. Variables predictive for OT were identified and the following score for the likelihood of having OT was developed: age (points = number of years) minus 3 points (if vomitus = "yes") and plus 1 point (if "pain duration >12 hours").A total of 80 patients with acute adnexal pathologies were identified. OT was recorded in 17 (21%) cases and ovarian cysts (OC) only in 63 (79%) cases. Patients who presented with OT were significantly younger than patients with OC only (P = .001). Correspondingly, 11 (65%) of the patients with OT had no menarche compared to 3 (5%) patients with OC only (P = .001). Vomiting (P = .001), a shorter pain duration (P = .01), and an elevated C-reactive protein (CRP) (P = .01) were observed significantly more often in patients with OT. The sensitivity of a positive OT score was 0.81 and increased to 1.00 if restricted to girls between 2 to 12 years of age.The presence of vomiting, short duration of abdominal pain, and elevated CRP level have a predictive value for the diagnosis of OT. In these patients, an exploratory laparoscopy should be conducted without delay. The presented OT score appears to be a helpful tool in diagnosing OT in children.
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