Key Clinical Predictors in the Early Diagnosis of Adnexal Torsion in Children

Objective: Adnexal torsion (AT) accounts for 2.7% of cases of acute abdominal pain in children. When AT is undiagnosed, ovarian blood supply is compromised, eventually leading to tissue necrosis. Because the clinical presentation of AT is nonspecific, preoperative diagnosis is challenging. The purpose of this study was to identify predictors that differentiate AT from other sources of acute abdominal pain. Methods: This study was an IRB-approved retrospective chart review of girls age 4-18 y/o with acute abdominal pain who then underwent surgical evaluation. Data collected included age, menarchal status, symptoms, physical exam findings, laboratory tests, imaging studies, operative procedures and postoperative diagnosis. Factors associated with AT were included in a logistic regression model. A receiver operator characteristic (ROC) curve based on this model was then constructed in order to determine its ability to predict AT. Results: 94 patients presented with acute abdominal pain; 45 were diagnosed with AT and 49 with other causes of abdominal pain. Presence of intermittent pain (P < .0217), non-radiating pain (P < .0229) and increased adnexal size (P < .0032) were significantly associated with AT in the final model. The area under the ROC curve was equal to 0.8601, suggesting excellent discrimination between AT and other causes of acute abdominal pain by using these 3 parameters. Conclusion: Key clinical and imaging findings can aid in the early diagnosis of AT in children. Future prospective studies will focus on development of a clinical predictive model for the diagnosis of AT in the pediatric population.