title: Ovarian torsion: diagnosis of inclusion mandates earlier intervention.
abstract: OBJECTIVE
  The treatment of ovarian torsion (OT) is often delayed because of diagnostic uncertainty and dependence on radiologic confirmation. In contrast, when testicular torsion (TT) is suspected, diagnosis and management are expedited despite lack of certainty, and operative exploration is not delayed by radiologic investigations. We compared the management of torsion in both sexes to define a better clinical pathway for suspected OT.
  
  
  METHODS
  A 2.5-year review of the Pediatric Health Information System database was performed to determine the incidence of TT and OT at large children's hospitals. A 10-year retrospective review of children (0-19 years) diagnosed with TT or OT at a single academic center was performed to identify differences in diagnosis and management and determine the impact on gonadal salvage rates.
  
  
  RESULTS
  The incidence of TT was comparable with OT in the Pediatric Health Information System database (0.03% vs 0.02%). A total of 158 patients with TT and 90 patients with OT were managed at our center with a median age of 12 years in both groups. Boys presented earlier after the onset of pain (36 vs 72 hours, P < .0001) and were imaged more quickly (0.77 vs 1.86 hours, P < .0001). Time to operating room (OR) was also shorter for TT (2.3 vs 6.3 hours, P < .0001). The salvage rate for TT was 30.3% vs 14.4% for OT (P < .01).
  
  
  CONCLUSIONS
  Girls with suspected OT waited 2.5 times as long for diagnostic imaging and 2.7 times as long to be taken to the operating room. In addition, the gonadal salvage rate was significantly worse for girls compared with boys with TT. More urgent intervention for OT, with liberal use of diagnostic laparoscopy and without reliance on a definitive diagnosis by imaging, should be considered in girls with lower abdominal pain.
authors.affiliation: Division of Pediatric Surgery, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, Canada. hannah.piper@sickkids.ca
authors.forename: Hannah G
authors.initials: HG
authors.lastname: Piper
authors.forename: Sarah C
authors.initials: SC
authors.lastname: Oltmann
authors.forename: Lin
authors.initials: L
authors.lastname: Xu
authors.forename: Sri
authors.initials: S
authors.lastname: Adusumilli
authors.forename: Anne C
authors.initials: AC
authors.lastname: Fischer
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D057210:Delayed Diagnosis / Q000706:statistics & numerical data; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010049:Ovarian Diseases / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery; D010052:Ovariectomy / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013086:Spermatic Cord Torsion / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery; D013781:Texas / Q000453:epidemiology; D013997:Time Factors; D014102:Torsion Abnormality / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery; D016896:Treatment Outcome; D055815:Young Adult