49. Applicability of an Established Composite Scoring System for Predicting Adnexal Torsion in African American Pediatric Patients

Abstract

<h3>Background</h3> Adnexal torsion can be difficult to diagnose. A prospective 2017 study focusing on the pediatric and adolescent population showed great promise in the development of an ultrasound-based scoring system used to predict this condition. However, the patient population was almost homogenously Caucasian, limiting its applicability in more ethnically diverse settings. We sought to clarify whether this scoring system maintained its validity when used in a primarily African American population, and in patients with a BMI >25. <h3>Methods</h3> A retrospective chart review was performed to identify cases of pediatric ovarian torsion, confirmed by laparoscopy, over the course of 10 years at a tertiary referral center. Inclusion criteria were: pediatric and adolescent girls between the ages of 0-21, and surgically proven cases of torsion diagnosed by ultrasound imaging. Exclusion criteria included: pregnancy of unknown location, preoperative imaging with CT only, or other suspected preoperative diagnoses (e.g. appendicitis, hemorrhagic cyst). Established clinical and ultrasound predictors of torsion were identified through chart and image review for their correlation to adnexal torsion. Using the established scoring system, a score was then applied to these confirmed torsion cases to determine whether or not the score would have successfully identified the torsion. <h3>Results</h3> A total of 53 cases of surgically proven ovarian torsion were found meeting the above criteria. Of the patients included 25% were premenarchal, while the remainder were postmenarchal. Approximately 60% were African American, 10% were Hispanic, and 30% were Caucasian. The average BMI across all ethnicities was 29. Applying the scoring system to these known cases, we found that our post hoc calculated scores correlated with the predictors previously identified. Primarily; adnexal mass, ovarian edema, leukocytosis, nausea/vomiting, adnexal ratio, and ovarian volume were all significantly associated with ovarian torsion (p < 0.05). Temperature, absence of arterial/venous flow, peripheral cysts, and pelvic free fluid were not associated with ovarian torsion. If applied prospectively to our patient population, over 90% of cases of confirmed torsion could have been identified by the composite score discussed above. <h3>Conclusions</h3> Widespread use of a non-invasive scoring system to predict adnexal torsion has the potential to significantly improve the timely assessment and management of young women with this condition. Our study suggests that a previously published composite score for torsion, using clinical and ultrasound findings, can successfully be used to predict torsion in African American and high BMI premenarchal and postmenarchal adolescents.