Clinical Research Coordinator The Children's Hospital of Philadelphia The University of Pennsylvania Philadelphia, Pennsylvania, United States
Background: Various imaging techniques are used to evaluate for adnexal torsion (AT) with ultrasound (US) being most common, even though discordant results may be found at time of operation.
Objective: We sought to correlate clinical characteristics and imaging findings with intra-operative diagnosis of AT.
Design/Methods: We reviewed 378 patient records identified by surgical procedure codes for adnexal pathology between 1/1/15-12/31/19. We included children 1-18 years old with clinical concern for ovarian/tubal/adnexal torsion, defined as mention of “torsion” in surgical, admission, and ED encounter notes. Clinical characteristics abstracted included age, pubertal status, nausea and/or vomiting (N/V), fever, abdominal pain or tenderness. We recorded imaging modality and findings obtained prior to surgery. The incidence of confirmed intra-operative AT among the total number of patients taken to surgery for imaging concern for torsion was determined.
Results: 198 children met inclusion criteria; 94/198 (47%) had an intra-operative diagnosis of AT and 104/198 (53%) had an alternative intra-operative diagnosis. 186/198 had US performed. Of these, 89/186 (48%) had US concerning for torsion; 61/89 (69%) were confirmed intra-operatively. 97/186 (52%) had US not concerning for torsion with 30/97 (31%) of these confirmed as torsion intra-operatively (US Se/Sp = 69%/69%).
Of 94 patients with confirmed AT, 92 (98%) had abdominal pain (3.0 days average duration), 57 (61%) had N/V, 11 (12%) had history of fever, and 79 (84%) had tenderness/guarding on exam. In this cohort, 37 (39%) were pre-menarchal, 51 (54%) were post-menarchal, and 6 (6%) were not documented.
Of 104 patients without AT, 103 (99%) had abdominal pain (7.1 days average duration), 56 (54%) had N/V, 11 (11%) had history of fever, and 93 (89%) had tenderness or guarding on exam. Of the 104, 14 (13%) were pre-menarchal, 85 (82%) were post-menarchal, and 5 (5%) were not documented. Conclusion(s): Approximately half of patients in our institution taken to surgery with clinical and radiographic concern for AT in the ED have confirmed torsion intra-operatively. Rates of abdominal pain and tenderness, vomiting, and fever were similar in those patients with torsion and those with alternate pelvic pathologies. Future studies are needed to better define clinical decision rules and best supporting radiographic imaging studies to inform which patients truly require operative evaluation for torsion.
Authors/Institutions: Elena Tsemberis, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States; Christopher Hoffman, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States; Summer Kaplan, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States; Gary Nace, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States; Maria C. Velez, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States; Aaron E. Chen, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States; Eron Friedlaender, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
