Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Apr;31(2):132-137.
doi: 10.1016/j.jpag.2017.08.007. Epub 2017 Aug 26.

Creation of a Composite Score to Predict Adnexal Torsion in Children and Adolescents

Beth I Schwartz  1 , Jill S Huppert  2 , Chen Chen  3 , Bin Huang  3 , Jennifer L Reed  4
Affiliations

Creation of a Composite Score to Predict Adnexal Torsion in Children and Adolescents

Beth I Schwartz et al. J Pediatr Adolesc Gynecol. 2018 Apr.

Abstract

Study objective: To create a composite score to predict adnexal torsion in children and adolescents.

Design: A prospective cross-sectional study.

Setting: Emergency department of a tertiary care children's hospital.

Participants: Three hundred twenty-four female participants aged 6-21 years who presented to the emergency department with lower abdominal pain and underwent ultrasound or computed tomography imaging.

Interventions: Collection of possible clinical and radiologic predictors of torsion.

Main outcome measures: The primary outcome was a composite score to predict adnexal torsion. We used χ2 analyses to identify possible risk factors. The classification and regression tree decision method was used to identify risk factor cutoff points. Independent risk factors were combined into a composite score. Receiver operating characteristic curve analyses were used to assessed score performance.

Results: Of 324 participants with abdominal pain, 241 underwent imaging, and 6.6% (16 of 241) had torsion. Duration of pain, intermittent pain, nausea, and absence of arterial or venous flow were not associated with torsion. Vomiting (P = .05 in premenarchal subjects; P < .001 in menarchal subjects), adnexal volume (P = .008 in premenarchal subjects; P < .001 in menarchal subjects), and adnexal volume ratio (P = .04 in premenarchal subjects; P < .001 in menarchal subjects) were independent predictors of torsion. These predictors were incorporated into a composite score. No torsions were identified with a score of less than 2. There was an increasing risk of torsion for each 1-point score increase.

Conclusion: Independent predictors of torsion can reliably be combined into a composite score to identify children and adolescents at risk for adnexal torsion. This score might aid in improving triage and management of these challenging patients.

Keywords: Adnexa; Adolescents; Children; Composite score; Diagnosis; Female; Ovary; Torsion.

PubMed Disclaimer

LinkOut - more resources