MIAMI BEACH – Certain clinical factors – and a scoring system that incorporates them – could help physicians in the differential diagnosis of adnexal torsion when girls present with acute abdominal pain, according to a small retrospective study.
Researchers compared 45 pediatric patients who had adnexal torsion confirmed at the time of surgery vs. another 49 without this problem to determine factors associated with higher risk. Abdominal tenderness, type of pain, pain radiation, ovary size (as well presence of a mass, and its size and palpability) were found to be potential predictors. Ultimately, however, the following three combined factors emerged as significantly associated with adnexal torsion:
• Presence of intermittent pain.
• Absence of radiating pain.
• An adnexal mass larger than 4 cm.
"There was a high level of distinction as to who had ovarian torsion and who did not," Dr. Cynthia Abraham said. "If they have these three factors, they should go straight to the OR."
In statistical terms, an area under the curve of 0.8601 on a receiver operating curve for these three factors "suggests an excellent discrimination between adnexal torsion and other causes of abdominal pain."
"This study thus demonstrates that key clinical and imaging parameters can be combined into a model that can aid in the early diagnosis of adnexal torsion," Dr. Abraham said at a poster during the annual meeting of the North American Society for Pediatric and Adolescent Gynecology. Girls included in the study were aged 2-18 years.
Even though the condition occurs in only 3% of patients with abdominal pain, adnexal torsion can be life threatening, and the differential diagnosis from other etiologies (for example, appendicitis or gastritis) is important. "The diagnosis is extremely critical and may lead to ovarian salvage," she added. If the diagnosis is missed or delayed, tissue necrosis and a diminished future fertility could ensue.
A weighted scoring system based on these factors would be helpful because "very often gynecologists are called to evaluate many patients who do not have ovarian torsion," said Dr. Abraham, a fourth year resident at the Steven and Alexandra Cohen Children’s Medical Center of New York, New Hyde Park
"Other studies have looked at physical examination and history," Dr. Abraham said. "We looked at a score for ovarian torsion." The scoring system is still in development. "We have not used it yet [in practice]. That is the next step."
Dr. Abraham said she had no relevant financial disclosures.