Statistical validation of the shorter-moldwin food sensitivity questionnaire for patients with interstitial cystitis/bladder pain syndrome.

PURPOSE: American Urological Association guidelines suggest dietary changes as first line treatment for interstitial cystitis/bladder pain syndrome. We previously developed a validated survey instrument to determine which foods, beverages and supplements exacerbate the symptoms of this condition. In this study we developed a shortened questionnaire that would provide an easily self-administered food symptom history useful for clinical practice and future research. MATERIALS AND METHODS: Using data from our previously validated food sensitivity questionnaire we remodeled the original lengthy survey to an abbreviated list including the 35 most problematic comestibles. The instrument was reviewed by a panel of experts for face and content validity, and tested for internal consistency, readability and clarity, and test-retest reliability. RESULTS: Of the 124 patients who completed a baseline questionnaire 52 (42%) returned the second instrument 1 week after completing the first instrument. Internal consistency was high (α=0.96). A total of 47 patients (90.4%) indicated that they were food sensitive. Questionnaire test-retest reliability assessed by the Spearman correlation coefficient ranged from moderate (ρ=0.48 for Equal®) to very strong (ρ=0.90 for beer). Discrepancies between the survey instruments in individual comestibles occurred only 1% of the time. CONCLUSIONS: Our short form diet history questionnaire based on a previously validated long form is a reliable, newly validated instrument that will help identify comestibles associated with interstitial cystitis/bladder pain syndrome symptoms. Its brevity makes it simple to administer and useful for dietary management in this population.

Key clinical predictors in the early diagnosis of adnexal torsion in children.

OBJECTIVE: Adnexal torsion (AT) accounts for 2.7% of cases of acute abdominal pain in children. When AT is undiagnosed, ovarian blood supply is compromised, eventually leading to tissue necrosis. Because the clinical presentation of AT is nonspecific, preoperative diagnosis is challenging. The purpose of this study was to identify predictors that differentiate AT from other sources of acute abdominal pain. METHODS: This study was an IRB-approved retrospective chart review of girls age 4-18 y/o with acute abdominal pain who then underwent surgical evaluation. Data collected included age, menarchal status, symptoms, physical exam findings, laboratory tests, imaging studies, operative procedures and postoperative diagnosis. Factors associated with AT were included in a logistic regression model. A receiver operator characteristic (ROC) curve based on this model was then constructed in order to determine its ability to predict AT. RESULTS: 94 patients presented with acute abdominal pain; 45 were diagnosed with AT and 49 with other causes of abdominal pain. Presence of intermittent pain (P < .0217), non-radiating pain (P < .0229) and increased adnexal size (P < .0032) were significantly associated with AT in the final model. The area under the ROC curve was equal to 0.8601, suggesting excellent discrimination between AT and other causes of acute abdominal pain by using these 3 parameters. CONCLUSION: Key clinical and imaging findings can aid in the early diagnosis of AT in children. Future prospective studies will focus on development of a clinical predictive model for the diagnosis of AT in the pediatric population.