Creation of a Composite Score to Predict Adnexal Torsion in Children and Adolescents

Study Objective: To create a composite score to predict adnexal torsion in children and adolescents. Design: A prospective cross-sectional study. Setting: Emergency department of a tertiary care children's hospital. Participants: Three hundred twenty-four female participants aged 6-21 years who presented to the emergency department with lower abdominal pain and underwent ultrasound or computed tomography imaging. Interventions: Collection of possible clinical and radiologic predictors of torsion. Main Outcome Measures: The primary outcome was a composite score to predict adnexal torsion. We used χ² analyses to identify possible risk factors. The classification and regression tree decision method was used to identify risk factor cutoff points. Independent risk factors were combined into a composite score. Receiver operating characteristic curve analyses were used to assessed score performance. Results: Of 324 participants with abdominal pain, 241 underwent imaging, and 6.6% (16 of 241) had torsion. Duration of pain, intermittent pain, nausea, and absence of arterial or venous flow were not associated with torsion. Vomiting (P =.05 in premenarchal subjects; P <.001 in menarchal subjects), adnexal volume (P =.008 in premenarchal subjects; P <.001 in menarchal subjects), and adnexal volume ratio (P =.04 in premenarchal subjects; P <.001 in menarchal subjects) were independent predictors of torsion. These predictors were incorporated into a composite score. No torsions were identified with a score of less than 2. There was an increasing risk of torsion for each 1-point score increase. Conclusion: Independent predictors of torsion can reliably be combined into a composite score to identify children and adolescents at risk for adnexal torsion. This score might aid in improving triage and management of these challenging patients.