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A Case–Control Study of Sonographic Maximum Ovarian Diameter as a Predictor of Ovarian Torsion in Emergency Department Females With Pelvic Pain
Author(s) -
Budhram Gavin,
Elia Tala,
Dan Jeff,
Schroeder Michele,
Safain Golien,
Schlech Walter,
Friderici Jennifer,
Knee Alex,
Anthouard Magalie,
Schoenfeld Elizabeth
Publication year - 2019
Publication title -
academic emergency medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.221
H-Index - 124
eISSN - 1553-2712
pISSN - 1069-6563
DOI - 10.1111/acem.13523
Subject(s) - medicine , emergency department , ovarian torsion , pelvic pain , general surgery , radiology , nursing
Background Color and power Doppler ultrasound are commonly used in the evaluation of ovarian torsion but are unreliable. Because normal‐sized ovaries are unlikely to cause torsion, maximum ovarian diameter ( MOD ) could theoretically be used as a screening test in the ED . Identification of MOD values below which torsion is unlikely would be of benefit to providers interpreting radiology department or point‐of‐care pelvic ultrasound. Objectives The objective was to determine if sonographic MOD can be used as a screening tool to rule out torsion in selected patients. Methods Via a retrospective case–control study spanning a 14‐year period, we examined the ultrasound characteristics of patients with torsion and age‐matched controls, all presenting to the emergency department with lower abdominal pain and receiving a radiology department pelvic ultrasound for “rule‐out torsion.” Standardized data collection forms were utilized. Distributions of MOD were compared and sensitivity, specificity, and likelihood ratios were calculated for multiple cutoffs. Results We identified 92 cases of surgically confirmed ovarian torsion and selected 92 age‐matched controls. In postmenarchal patients the sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio of 3‐ and 5‐cm MOD s were 100% (96%–100%), 30% (20%–41%), 1.4 (1.3–1.7), and 0 and 91% (83%–97%), 92% (83%–97%), 11.2 (5.5–22.9), and 0.09 (0.04–0.19), respectively. The 5‐cm MOD , however, excluded an additional 52 of 84 (62%) postmenarchal patients. Conclusions A threshold MOD of 5 cm on pelvic ultrasound may be useful to rule out ovarian torsion in postmenarchal females presenting with lower abdominal and pelvic pain.