title: The utility of a composite index for the evaluation of ovarian torsion.
abstract: OBJECTIVE
  Ovarian torsion (OT) is a clinical diagnosis with a variable presentation. The aim of this study was to develop a practical scoring system to predict patients with OT in the pediatric population to facilitate more accurate diagnosis.
  
  
  METHODS
  A retrospective study evaluating menarchal pediatric patients (1998 to 2005) with surgically confirmed OT (n = 28) compared with patients with abdominal pain and surgically confirmed non-OT (n = 26). Histogram analysis was performed to determine threshold values and used to generate the OT composite index (OT-CI).
  
  
  RESULTS
  Four factors were independently associated with OT: ovarian ratio, ovarian volume, nausea, and duration of pain. Arterial and venous Doppler flows were not associated with OT. The OT-CI was more accurate than any individual factor. There were no cases of OT in patients with OT-CI scores < 3. Patients with score ≥ 3 had 100% sensitivity and 65.3% specificity. A score ≥ 5 has 100% specificity.
  
  
  CONCLUSIONS
  The OT-CI is a practical scoring system combining clinical and radiologic findings to more accurately predict OT. An OT-CI score < 3 is strong evidence against OT in pediatric menarchal patients, which may minimize unnecessary surgical intervention. In contrast, scores ≥ 3 should be considered for surgical intervention to maximize ovarian salvage.
authors.affiliation: Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States.
authors.forename: Alice
authors.initials: A
authors.lastname: King
authors.affiliation: Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States.
authors.forename: Sundeep
authors.initials: S
authors.lastname: Keswani
authors.affiliation: Division of Biomedical Informatics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States.
authors.forename: Jacek
authors.initials: J
authors.lastname: Biesiada
authors.affiliation: Division of Obstetrics and Gynecology, Pediatrics and Pediatric Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States.
authors.forename: Lesley
authors.initials: L
authors.lastname: Breech
authors.affiliation: Division of Pediatric Surgery, Children's Hospital Colorado, Aurora, Colorado, United States.
authors.forename: Timothy
authors.initials: T
authors.lastname: Crombleholme
authors.affiliation: Division of Obstetrics and Gynecology, Pediatrics and Pediatric Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States.
authors.forename: Jill
authors.initials: J
authors.lastname: Huppert
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000293:Adolescent; D002648:Child; D005260:Female; D006801:Humans; D009325:Nausea / Q000209:etiology; D010049:Ovarian Diseases / Q000175:diagnosis*; D010053:Ovary / Q000000981:diagnostic imaging; D011859:Radiography; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014102:Torsion Abnormality / Q000175:diagnosis*; D014463:Ultrasonography; D014839:Vomiting / Q000209:etiology