| Title: |
The Tubo‐ovarian abscess study ( TOAST): A single‐center retrospective review of predictors of failed medical management |
| Authors: |
Marshall, Anna; Wimsett, Jordon; Handforth, Charlotte; Unsworth, Louise; Wilson, Jessica; Van Der Merwe, Anna‐Marie; Oyston, Charlotte |
| Source: |
International Journal of Gynecology & Obstetrics ; volume 170, issue 2, page 927-935 ; ISSN 0020-7292 1879-3479 |
| Publisher Information: |
Wiley |
| Publication Year: |
2025 |
| Collection: |
Wiley Online Library (Open Access Articles via Crossref) |
| Description: |
Objective Tubo‐ovarian abscesses (TOAs) cause significant morbidity. Surgical intervention is required if broad‐spectrum intravenous antibiotics are unsuccessful. This study aimed to describe admission characteristics that predict failed medical management and to evaluate a previously developed risk score for predicting the need for surgical intervention in cases of TOA. Design Single centre, retrospective cohort study. Setting and Patients Patients admitted to a tertiary‐level public teaching hospital with a radiologically or surgically proven TOA between January 1, 2012 and December 31, 2018. Measures Demographic and clinical details were obtained from electronic clinical records. Medical treatment was considered “failed” when surgical intervention was required beyond 24 h of antibiotics. Multivariable analyses using logistic regression was used to determine predictors of failed medical management. Risk scores were calculated as per Fouks et al. and a receiver operating characteristic curve was constructed to assess correlation with outcomes. Results There were 425 patients and 522 admissions with TOA. In the first 24 h, 14% (72/522) of admissions were treated with a surgical intervention in addition to intravenous (IV) antibiotics, while 86% (450/522) were treated with IV antibiotics alone. In those treated with IV antibiotics alone, medical treatment was successful in 65% (293/450) of cases, with 35% (159/450) requiring additional surgical or radiological intervention prior to discharge. Variables independently associated with failed medical treatment were fever at admission (adjusted odds ratio [aOR] 1.72, 95% confidence interval [CI] 1.11–2.67), larger mean diameter of TOA (2% higher odds for every 1‐mm increase in abscess size) and higher C‐reactive protein value (1% higher odds for every unit increase) at admission. The area under the curve (95% CI) for Fouks et al. scoring system was 0.63 (0.58–0.68), indicating poor discriminatory ability. Conclusions A third of TOAs managed medically required ... |
| Document Type: |
article in journal/newspaper |
| Language: |
English |
| DOI: |
10.1002/ijgo.70100 |
| Availability: |
https://doi.org/10.1002/ijgo.70100; https://obgyn.onlinelibrary.wiley.com/doi/pdf/10.1002/ijgo.70100 |
| Rights: |
http://creativecommons.org/licenses/by/4.0/ |
| Accession Number: |
edsbas.E661F28 |
| Database: |
BASE |