Adnexal Torsion: A Predictive Score for Pre-operative DiagnosisHuchon C., Staraci S., Fauconnier A.(2010) 25(9): 2276-2280.
Adnexal torsion (AT) is a gynaecological emergency requiring urgent surgery. The signs and symptoms are non-specific and therefore diagnostic laparoscopy is indicated in cases of high suspicion. Failure to interpret the clinical features appropriately may lead to ovarian loss or peritonitis with its associated mortality. The authors have sought to reduce unnecessary surgical intervention and expedite treatment by developing a predictive score for emergency use.
The title may be misleading, in that laparoscopy will remain the only means of definitive diagnosis of AT. This predictive tool stratifies women presenting as being high, intermediate or low-risk.
A retrospective cohort study was undertaken over a 16 month period. The inclusion and exclusion criteria appear adequate. A total of 145 patients were identified who had diagnostic laparoscopy for suspected torsion. 15 clinical criteria from history, examination and investigation were subjected to univariate analysis with 'torsion score' points allocated to identify those with most predictive value. Multiple regression procedures yielded 5 criteria with good sensitivity/specificity/likelihood ratio profiles. The presence of 3, 4 or 5 of these clinical features appeared indicative of high risk of AT (torsion score >60). The 5 identified were:
- Unilateral lumbar/abdominal pain
- Duration of pain < 8 hours at presentation
- Pain accompanied by vomiting
- Absence of leucorrhoea and metrorrhagia
- Ovarian cyst >5cm diameter, seen on transvaginal ultrasonographic imaging.
Following development, the predictive tool was applied prospectively to 35 women presenting with acute pelvic pain, with good sensitivity and specificity profiles for the low and high-risk groups.
The predictive performance indicates the potential usefulness of this simple tool, to apply torsion score in stratifying acute pelvic pain presentations. It is unavoidable that many patients will continue to be treated solely on the balance of risk.