Title : ED to OR door-to-door time after implementation of the composite adnexal torsion prediction score in adolescent patients at Prisma Health Midlands
Abstract:
Background: Adnexal torsion is a surgical emergency in children and adolescents and is a diagnosis that continues to stump healthcare providers. Independent predictors of torsion, both clinical and radiographic, have been identified and incorporated into a composite scoring system. Research studies are underway to determine the generalizability of these scores in diverse patient populations in hopes that this becomes a widely accepted tool used by healthcare professionals to improve prompt diagnosis and treatment of adnexal torsion. Previously, a retrospective chart review using this composite score on the Prisma Health pediatric population did find that it successfully predicted torsion in the study population. This study also found an average door-to-door time from ED to OR of 47.1 hours (n=53) for adnexal torsion cases between 2010 and 2019.
Purpose: The purpose of this study is to use the original Schwartz et al. composite score to predict adnexal torsion and apply it to our patient population at Prisma Health Midlands in a prospective manner in order to further validate its generalizability. We aim to investigate the average time to OR for suspected cases of torsion between 2021 to 2023 after implementing the CAT score. We will compare door-to-door time of previous adnexal torsion retrospective study to that of our preliminary prospective study to access improvement in time to intervention.
Methods: We created an Epic smartphrase for the torsion predictor scoring system and encouraged OBGYN, Emergency Medicine, and Pediatric providers at Prisma Health Midlands to utilize this diagnostic tool when evaluating their patients with concern for adnexal torsion. Statistical analysis will then be performed on the data to determine how reliable the torsion predictor score is at identifying adnexal torsion in pediatric and adolescent patients as well as identifying any improvement in ER to OR door-to-door time.
Results: Currently, our early prospective data also appears to be corroborating the utility of this composite score in predicting adnexal torsion. Composite score had 100% sensitivity and 96% specificity in our patient population. Average time to OR for confirmed torsion cases, thus far, after presentation to the ED decreased from 47.1 hours (n=53) to 8.14 hours (n=5).
Conclusions and Implications: The torsion predictor score appears to be generalizable to our diverse patient population and will likely serve as a valuable diagnostic tool in providing prompt surgical management for adnexal torsion in the future. From the data gathered thus far, the ER to OR door-to-door time has significantly decreased. However, our sample size of surgically proven torsion cases remains low and data is still being collected.
Audience Take Away:
- The audience will learn what the composite adnexal torsion (CAT) score is.
- The audience will be able to use this user-friendly algorithm in their own clinical duties to assist in identifying patients who may presenting with adnexal torsion in a timely manner.
- Other faculty could also implement the CAT score at their institutions in order to further attest to its generalizability.
