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

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.