Journal Club: October 2020

Creation of a Composite Score to Predict Adnexal Torsion in Children and Adolescents

Beth I. Schwartz MD, Jill S. Huppert MD, MPH, Chen Chen PhD, Bin Huang PhD, Jennifer L. Reed MD,MS


  1. The authors state in the Materials and Methods that at the institution of study, ultrasound protocol includes evaluation of Doppler flow of the adnexa, but that this is not always performed at outside institutions. What is the protocol for imaging at your institution and is Doppler always performed?

  2. Classification and regression tree (CART) decision method analysis was used to determine appropriate cut off points for risk ratios. Describe why this predictive analytic test was used to determine cut off points for this study. Evaluate Table 1 and Table 2 and explain the CART decision tree results for adnexal volume and adnexal ratio for both premenarchal and menarchal subjects.

  3. Why was a receiver operating characteristic (ROC) curve analysis used in this study? Evaluate Figure 2 and explain the x and y axis of the figure. What does an area under the curve result of 0.9488 signify?

  4. What are limitations in diagnosing adnexal torsion? Consider reviewing ACOG Committee Opinion 783: Adnexal Torsion in Adolescents. How does this study strive to overcome barriers to diagnosis in comparison to past studies on adnexal torsion?

  5. What were the main independent predictors of adnexal torsion? What was not found to be an accurate predictor of torsion in this study? Will this change your clinical approach to these patients in the future?

  6. In the Discussion the authors state that the scoring system has been incorporated into clinical practice and give an explanation of parameters. Do you agree with the use of this scoring tool in clinical practice?