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The Utility of A Composite INDEX for the Evaluation of Ovarian Torsion

Saturday, October 20, 2012: 8:12 AM
Versailles Ballroom (Hilton Riverside)
Alice Leung, MD1, Jill Huppert, MD2, Samantha Montgomery, MD2, Timothy M. Crombleholme, MD, FACS, FAAP3 and Sundeep G. Keswani, MD4, (1)Division of Pediatric General & Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, (2)Cincinnati Children's Hospital Medical Center, Cincinnati, OH, (3)Department of Pediatric General & Thoracic Surgery, Children's Hospital Colorado, Aurora, CO, (4)Department of Pediatric General & Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH

Purpose

Ovarian torsion (OT) is a clinical diagnosis with a variable presentation. In predicting OT, our group has previously demonstrated 1) the utility of sonographic assessment of adnexal volumes and 2) the limited value of transabdominal Doppler flow in the accurate diagnosis of ovarian torsion. History and clinical presentation are recognized as key factors in the diagnosis of OT. Taken together, we hypothesized a composite index combining clinical and radiologic findings would more accurately predict patients with OT when compared to individual factors. To test our hypothesis, we retrospectively evaluated patients with OT to determine findings associated with OT and designed an ovarian torsion composite index (OT-CI).

Methods

With IRB approval, a retrospective review of OT (1998-2005) in our tertiary care children's hospital was conducted. We compared menarchal patients with abdominal pain with surgically confirmed absence (control; n=26) or surgically confirmed presence (case; n=28) of OT. We evaluated the following factors for association with the diagnosis of OT: adnexal ratio, adnexal volume, arterial Doppler flow, venous Doppler flow, nausea and duration of symptoms.   Of the factors associated with OT, we performed histogram analysis and determined threshold values to generate the OT-CI. These variables were evaluated with accuracy and receiver operating characteristic (ROC) curve analysis. Statistical analysis by DeLong's test.

Results

Histogram analysis identified adnexal ratio (AR), adnexal volume (AV), nausea (N) and duration of symptoms (D) as predictive of OT and were used to generate the OT-CI. The composite index is shown in Figure 1. Arterial and venous Doppler flows were not associated with OT. The OT-CI was more accurate than any individual variable (OT-CI: 85.2%, AR: 79.6%, AV: 83.3%, N: 74.1% vs D: 74.1%). There were no cases of OT in patients with a score of less than 3 (Table 1). Patients with score greater than or equal to 3 had 100% sensitivity and 65.3% specificity for detecting OT. A score ≥5 has 100% specificity for OT. The OT-CI was superior to any individual variable alone in discriminating OT (OT-CI: 94.2 vs AR: 82.5, p=0.009; OT-CI: 94.2 vs AV: 88.0, p=0.06).

Conclusion

We developed an ovarian torsion composite index combining clinical and radiologic findings in order to more accurately predict OT. An OT-CI score less than 3 is strong evidence against OT in menarchal patients in efforts to minimize unnecessary surgical intervention. In contrast, scores of 3 or more should be considered for surgical intervention to maximize ovarian salvage. The OT-CI has the potential to be a valuable diagnostic tool for OT, but must be prospectively validated.

Ovarian Torsion

Non-Ovarian Torsion

Score

n

%

N

%

0-2

0

0

17

100

3-4

8

47

9

53

> 5

20

100

0

0

Total

28

26