Applicability of an Adnexal Torsion Prediction Score in Pediatric and Adolescent Patients

Abstract

Study Objective: A previously published Composite Adnexal Torsion (CAT) Score proposed a scoring system to assess the risk of adnexal torsion in children and adolescents by looking at three independent risk factors, vomiting, adnexal volume, and adnexal ratio.1 We sought to assess the applicability of this predictive model at a different institution, which has a higher proportion of Hispanic patients. We also sought to identify other sonographic features that are associated with adnexal torsion in this patient population. Methods: This was a retrospective cohort study. Participants included female patients age 0-21 years who presented to Phoenix Children’s Hospital Emergency Department for lower abdominal pain from January 1, 2016 to January 1, 2021. Only patients who had ultrasound or computed tomography imaging performed and subsequently underwent diagnostic surgery were included. Records were reviewed and Composite Adnexal Torsion scores were calculated retrospectively for each patient based on the scoring system. The key study measures included rate of ovarian torsion, composite score, and performance of the composite score. Univariate logistic regression was used to fit the odds of adnexal torsion for each CAT score. The area under the receiver operating curve (AUROC) was calculated in order to assess how well the model predicts torsion in this population. Results: A total of 39 cases of patients presenting for abdominal/pelvic pain who underwent surgery were included and reviewed. Of these, 14 (35.9%) had torsion confirmed on surgery. 50% of patients with CAT score >4 were found to have adnexal torsion with OR 2.22 (p = 0.29). 10.2% of patients with CAT score of 0-1 were found to have torsion. In this population, none of the previously identified risk factors of presence of vomiting, adnexal volume, or adnexal ratio significantly correlated with torsion: vomiting in 57.1% with torsion (p = 0.74), adnexal volume score = 2 in 35.7% (p = 0.24), and adnexal ratio > 21 in 14.3% (p = 1.00). Absence of Doppler flow to the affected adnexa was found to correlate with adnexal torsion (p < 0.01). The composite score values were found to have AUROC of 0.62. Conclusion: The proposed Composite Adnexal Torsion score was not found to be applicable in this population.