Department of Gynecology and Obstetrics, CHI Poissy Saint-Germain en Laye, Poissy, France.
Hum Reprod. 2012 Aug;27(8):2359-64. doi: 10.1093/humrep/des186. Epub 2012 Jun 6.
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.
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.
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 (Lr-) 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).
The SAQ-GE torsion score may prove useful for screening for AT in patients experiencing acute pelvic pain.
目前尚无附件扭转（AT）术前诊断用的问卷。我们的目的是基于专为急性盆腔痛女性分诊设计的妇科急症自我评估问卷（SAQ-GE），建立附件扭转预测模型。
我们进行了一项多中心前瞻性试验，在法国的五家医院进行。2006 年 9 月至 2008 年 4 月共纳入 496 例急性盆腔痛（数字评分量表>4）女性，其中 31 例为 AT。采用 SAQ-GE 建立 AT 评分。
手术证实的 5 项标准与 AT 独立相关：单侧腰痛或腹痛（校正诊断比值比[aDOR]，23.3；95%置信区间[95%CI]，3.0-178）；无白带和月经过多（aDOR，7.0；95%CI，2.5-20）、卵巢痛（aDOR，5.5；95%CI，1.5-21）、难以忍受的疼痛（aDOR，5.0；95%CI，1.4-18）和呕吐（aDOR，3.7；95%CI，1.6-9.0）。SAQ-GE 扭转评分基于这 5 项标准，其值范围为 0 至 10。基于评分值的低风险组（SAQ-GE 扭转评分<7），其敏感度（Se）为 96.7%（95%CI，90.5-100）、阴性预测值为 99.7%（95%CI，99.1-100）、阴性似然比（LR-）为 0.05，排除 AT 的概率为 0.3%（95%CI，0.0-0.9）。采用刀切法进行模型的交叉验证，得出无偏 Se 为 87.1%（95%CI，75.1-99.1）和特异性为 74.2%（95%CI，70.2-78.2）。
SAQ-GE 扭转评分可能有助于对急性盆腔痛患者进行 AT 筛查。
