Ovarian torsion: Diagnosis of inclusion mandates earlier intervention

Hannah G. Piper, Sarah C. Oltmann, Lin Xu, Sri Adusumilli, Anne C. Fischer

Research output: Contribution to journalArticle

28 Citations (Scopus)

Abstract

Purpose: 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.

Original languageEnglish (US)
Pages (from-to)2071-2076
Number of pages6
JournalJournal of Pediatric Surgery
Volume47
Issue number11
DOIs
StatePublished - Nov 2012

Fingerprint

Spermatic Cord Torsion
Health Information Systems
Operating Rooms
Databases
Pediatrics
Critical Pathways
Incidence
Diagnostic Imaging
Laparoscopy
Abdominal Pain
Uncertainty
Pain

Keywords

  • Gonad salvage
  • Ovarian torsion
  • Testicular torsion

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health

Cite this

Ovarian torsion : Diagnosis of inclusion mandates earlier intervention. / Piper, Hannah G.; Oltmann, Sarah C.; Xu, Lin; Adusumilli, Sri; Fischer, Anne C.

In: Journal of Pediatric Surgery, Vol. 47, No. 11, 11.2012, p. 2071-2076.

Research output: Contribution to journalArticle

Piper, Hannah G. ; Oltmann, Sarah C. ; Xu, Lin ; Adusumilli, Sri ; Fischer, Anne C. / Ovarian torsion : Diagnosis of inclusion mandates earlier intervention. In: Journal of Pediatric Surgery. 2012 ; Vol. 47, No. 11. pp. 2071-2076.
@article{464929c7e12145e2aaf842201ec83048,
title = "Ovarian torsion: Diagnosis of inclusion mandates earlier intervention",
abstract = "Purpose: 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.",
keywords = "Gonad salvage, Ovarian torsion, Testicular torsion",
author = "Piper, {Hannah G.} and Oltmann, {Sarah C.} and Lin Xu and Sri Adusumilli and Fischer, {Anne C.}",
year = "2012",
month = "11",
doi = "10.1016/j.jpedsurg.2012.06.011",
language = "English (US)",
volume = "47",
pages = "2071--2076",
journal = "Journal of Pediatric Surgery",
issn = "0022-3468",
publisher = "W.B. Saunders Ltd",
number = "11",

}

TY - JOUR

T1 - Ovarian torsion

T2 - Diagnosis of inclusion mandates earlier intervention

AU - Piper, Hannah G.

AU - Oltmann, Sarah C.

AU - Xu, Lin

AU - Adusumilli, Sri

AU - Fischer, Anne C.

PY - 2012/11

Y1 - 2012/11

N2 - Purpose: 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.

AB - Purpose: 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.

KW - Gonad salvage

KW - Ovarian torsion

KW - Testicular torsion

UR - http://www.scopus.com/inward/record.url?scp=84869478352&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84869478352&partnerID=8YFLogxK

U2 - 10.1016/j.jpedsurg.2012.06.011

DO - 10.1016/j.jpedsurg.2012.06.011

M3 - Article

C2 - 23164000

AN - SCOPUS:84869478352

VL - 47

SP - 2071

EP - 2076

JO - Journal of Pediatric Surgery

JF - Journal of Pediatric Surgery

SN - 0022-3468

IS - 11

ER -