Does this woman have adnexal torsion?

Abstract

background: No questionnaire is currently available for the presurgical diagnosis of adnexal torsion (AT). Our objective was to develop a predictive model for AT, based on the Self Assessment Questionnaire for Gynecologic Emergencies (SAQ-GE) designed for triaging women with acute pelvic pain. methods: We performed a multicenter prospective trial conducted in five hospitals in France. Four hundred and ninety-six (496) women with acute pelvic pain (Numeric Rating Scale .4), including 31 with AT, were recruited from September 2006 through April 2008. An AT score was built using the SAQ-GE. results: Five criteria were independently associated with AT confirmed by surgery: unilateral lumbar or abdominal pain [adjusted diagnostic odds ratio (aDOR), 23.3; 95% confidence interval (95% CI), 3.0-178]; absence of leucorrhea and metrorrhagia (aDOR, 7.0; 95% CI, 2.5-20), ovarian pain (aDOR, 5.5; 95% CI, 1.5-21), unbearable pain (aDOR, 5.0; 95% CI, 1.4-18) and vomiting (aDOR, 3.7; 95% CI, 1.6- 9.0). The SAQ-GE torsion score was based on these five criteria and its values range from 0 to 10. The low-risk group (SAQ-GE torsion score <7), based on the score values, has a sensitivity (Se) of 96.7% (95% CI, 90.5-100), a negative predictive value of 99.7% (95% CI, 99.1-100) and a negative likelihood ratio (Lr2) of 0.05, ruling out AT with a probability of AT of 0.3% (95% CI, 0.0-0.9). Cross-validation of the model was performed using the jackknife resampling procedure, retrieving an unbiased Se of 87.1 (95% CI, 75.1-99.1) and a specificity of 74.2% (95% CI, 70.2-78.2). conclusions: The SAQ-GE torsion score may prove useful for screening for AT in patients experiencing acute pelvic pain. © The Author 2012.