Adnexal Torsion: Narcotic Administration and Gynecologists’ Diagnostic Accuracy

Abstract

<h3>Study Objective</h3> To determine Gynecologists' accuracy in diagnosing adnexal torsion (AT) and determine differences in in the amount of narcotics administered in morphine milligram equivalent (MME) in patients who received gynecology consultation for AT. <h3>Design</h3> A retrospective cohort study between 2017-2020. <h3>Setting</h3> A tertiary, academic medical center. <h3>Patients or Participants</h3> 138 women received a gynecologic consultation in the emergency room to rule out AT. <h3>Interventions</h3> Surgical intervention. <h3>Measurements and Main Results</h3> 138 women met inclusion criteria. 32 of them (23%) underwent diagnostic laparoscopy for suspected AT, and 18 (56%) were confirmed to have AT. The MME median in patients undergoing surgery was 6.25 mg, which was significantly higher than 2.5 mg in patients who did not undergo surgery (p = 0.0011). MME medians for women who had surgically confirmed AT and those who underwent surgery but did not have AT were 7.25 mg and 4 mg respectively, which was not significantly different (p = 0.2221). Age, race (white vs non-white), payer status (insured vs uninsured), history of sexually transmitted disease or ovarian cyst, and pain severity did not differ between the group of women that underwent surgery and the group of women that did not. However, there was a significant difference in the presence of vomiting (p = <0.001), leukocytosis (p = 0.0073), and overall larger ovarian mass (p = <0.0001) in women who had surgery. On multivariate regression analysis controlling for leukocytosis and ovarian mass, MME was independently associated with the decision to proceed with surgery (p = 0.0119). <h3>Conclusion</h3> While this study highlights no statistically significant difference in MME administration and accuracy of AT diagnosis due to small sample size, there was a difference in MME administration between women undergoing surgery and those who did not. Determining which predictors and to what extent they may impact the diagnosis and decision to proceed with surgery remain an area that warrants further investigation.