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Development and validation of a predictive nomogram for pediatric ovarian torsion: a retrospective cohort study
Jinwen Meng1, Guannan Bai2, Jieni Xiong1
1Department of Surgical Oncology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Children and Adolescents' Health and Diseases, Hangzhou, China.
Background:
Delayed diagnosis of pediatric ovarian torsion, a challenging emergency, can lead to ovarian loss and compromised fertility. This study aimed to develop and validate a predictive nomogram by integrating clinical, laboratory and sonographic features to facilitate the early and accurate identification of ovarian torsion.
Methods:
We conducted a retrospective analyses of data from 201 pediatric patients who underwent emergency surgery for suspected ovarian torsion between October 2017 and October 2025. The cohort was randomly divided into a training set (n=140) and a validation set (n=61). Using univariate and multivariate logistic regression analysis, independent predictors of ovarian torsion were identified to construct a predictive nomogram. Its performance was rigorously evaluated in three domains: (I) discrimination, assessed by the area under the receiver operating characteristic curve (AUC); (II) calibration, assessed using calibration plots, the Brier score, and the Spiegelhalter test; and (III) clinical utility, measured through decision curve analysis (DCA).
Results:
The final multivariate model identified four independent predictors: age [odds ratio (OR) =0.67], neutrophil-to-lymphocyte ratio (NLR) (OR =1.23), the whirlpool sign (OR =7.09), and maximum ovarian diameter (OR =1.75). The nomogram demonstrated excellent discrimination, with an AUC of 0.915 [95% confidence interval (CI): 0.865-0.964] in the training set and 0.853 (95% CI: 0.711-0.994) in the validation set. Calibration analysis showed a strong correlation between predicted and actual probabilities. DCA verified that the nomogram offered a higher net benefit across a broad spectrum of threshold probabilities.
Conclusions:
A novel nomogram has been developed incorporating age, NLR, the whirlpool sign, and ovarian diameter to predict pediatric ovarian torsion. This tool can serve as an intuitive bedside instrument to aid clinicians in rapid risk stratification, thereby improving diagnostic decision-making and potentially increasing rates of ovarian salvage.
