A NEW multi-institutional study has revealed that nearly 30% of paediatric and adolescent patients with adnexal torsion, an emergency condition involving the twisting of the ovary or fallopian tube, experience delays in diagnosis and care, often leading to preventable tissue loss.
Researchers reviewed the cases of 862 females aged 5 to 18 across ten children’s hospitals between 2013 and 2022. They found that patients who lived more than 30 miles from the hospital or in areas with higher socioeconomic deprivation were significantly more likely to experience delays in care. In these cases, initial emergency department visits frequently failed to diagnose torsion, often resulting in discharge or admission without surgical planning.
The consequences of delay were stark: girls who did not receive prompt care were twice as likely to undergo oophorectomy, the surgical removal of an ovary, compared to those treated in a timely manner (14% vs. 7%).
Clinical presentation played a key role in timely diagnosis. Patients who did not exhibit symptoms such as vomiting or fever, or who had inconclusive ultrasound findings, were more likely to experience delayed treatment. Moreover, an early paediatric surgery consultation improved diagnostic accuracy and treatment speed.
“Adnexal torsion is notoriously difficult to diagnose, but delays can mean the difference between saving or losing an ovary,” said lead author Dr. Barrie S. Rich, paediatric surgeon at Cohen Children’s Medical Center.
The study emphasises the need for heightened clinical suspicion and targeted improvements in diagnostic protocols, particularly in underserved and geographically remote communities. Increasing awareness among emergency physicians and improving access to paediatric surgical consultation may help prevent unnecessary oophorectomies and safeguard future fertility.
Reference
Rich BS et al. Factors Associated With Delay to Care in Pediatric and Adolescent Adnexal Torsion. Pediatrics. 2025;155(3):e2024068204.
