The Utility of a Composite Index for the Evaluation of Ovarian Torsion

Abstract

Ovarian torsion (OT) is a clinical diagnosis with a variable presentation. The aim of this study was to develop a practical scoring system to predict patients with OT in the pediatric population to facilitate more accurate diagnosis. A retrospective study evaluating menarchal pediatric patients (1998 to 2005) with surgically confirmed OT (n = 28) compared with patients with abdominal pain and surgically confirmed non-OT (n = 26). Histogram analysis was performed to determine threshold values and used to generate the OT composite index (OT-CI). Four factors were independently associated with OT: ovarian ratio, ovarian volume, nausea, and duration of pain. Arterial and venous Doppler flows were not associated with OT. The OT-CI was more accurate than any individual factor. There were no cases of OT in patients with OT-CI scores < 3. Patients with score ≥ 3 had 100% sensitivity and 65.3% specificity. A score ≥ 5 has 100% specificity. The OT-CI is a practical scoring system combining clinical and radiologic findings to more accurately predict OT. An OT-CI score < 3 is strong evidence against OT in pediatric menarchal patients, which may minimize unnecessary surgical intervention. In contrast, scores ≥ 3 should be considered for surgical intervention to maximize ovarian salvage.