{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T23:08:01Z","timestamp":1792192081103,"version":"4.4.0"},"reference-count":22,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2025,3,31]],"date-time":"2025-03-31T00:00:00Z","timestamp":1743379200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,3,31]],"date-time":"2025-03-31T00:00:00Z","timestamp":1743379200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Intl J Gynecology &amp; Obste"],"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Tubo\u2010ovarian abscesses (TOAs) cause significant morbidity. Surgical intervention is required if broad\u2010spectrum 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Single centre, retrospective cohort study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting and Patients<\/jats:title>\n                    <jats:p>Patients admitted to a tertiary\u2010level public teaching hospital with a radiologically or surgically proven TOA between January 1, 2012 and December 31, 2018.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measures<\/jats:title>\n                    <jats:p>Demographic and clinical details were obtained from electronic clinical records. Medical treatment was considered \u201cfailed\u201d 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\u00a0al. and a receiver operating characteristic curve was constructed to assess correlation with outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                    <jats:p>Variables independently associated with failed medical treatment were fever at admission (adjusted odds ratio [aOR] 1.72, 95% confidence interval [CI] 1.11\u20132.67), larger mean diameter of TOA (2% higher odds for every 1\u2010mm increase in abscess size) and higher C\u2010reactive protein value (1% higher odds for every unit increase) at admission. The area under the curve (95% CI) for Fouks et\u00a0al. scoring system was 0.63 (0.58\u20130.68), indicating poor discriminatory ability.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>A third of TOAs managed medically required surgical intervention. Fever, higher inflammatory markers, and larger mass were predictive of requiring surgery. However, a scoring system using these variables had poor discriminatory ability to predict treatment failure. Prospective studies are needed to determine whether earlier recourse to surgery can improve outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ijgo.70100","type":"journal-article","created":{"date-parts":[[2025,4,1]],"date-time":"2025-04-01T06:53:23Z","timestamp":1743490403000},"page":"927-935","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["The Tubo\u2010ovarian abscess study (\n                    <scp>TOAST<\/scp>\n                    ): A single\u2010center retrospective review of predictors of failed medical management"],"prefix":"10.1002","volume":"170","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2399-2925","authenticated-orcid":false,"given":"Anna","family":"Marshall","sequence":"first","affiliation":[{"name":"Department of Obstetrics &amp; Gynaecology Te Whatu Ora, Counties Manukau  Auckland New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jordon","family":"Wimsett","sequence":"additional","affiliation":[{"name":"Department of Obstetrics &amp; Gynaecology University of Auckland  Auckland New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charlotte","family":"Handforth","sequence":"additional","affiliation":[{"name":"Department of Obstetrics &amp; Gynaecology University of Auckland  Auckland New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Louise","family":"Unsworth","sequence":"additional","affiliation":[{"name":"Department of Obstetrics &amp; Gynaecology Te Whatu Ora, Counties Manukau  Auckland New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica","family":"Wilson","sequence":"additional","affiliation":[{"name":"Department of Obstetrics &amp; Gynaecology University of Auckland  Auckland New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna\u2010Marie","family":"Van Der Merwe","sequence":"additional","affiliation":[{"name":"Department of Obstetrics &amp; Gynaecology Te Whatu Ora, Counties Manukau  Auckland New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1762-7905","authenticated-orcid":false,"given":"Charlotte","family":"Oyston","sequence":"additional","affiliation":[{"name":"Department of Obstetrics &amp; Gynaecology Te Whatu Ora, Counties Manukau  Auckland New Zealand"},{"name":"Department of Obstetrics &amp; Gynaecology University of Auckland  Auckland New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,3,31]]},"reference":[{"key":"e_1_2_11_2_1","volume-title":"Williams Gynecology","author":"Hoffman B","year":"2016"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jmig.2018.06.013"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/ijgo.13932"},{"key":"e_1_2_11_5_1","unstructured":"Centers for Disease Control and Prevention.Pelvic Inflammatory Disease (PID) \u2010 STI Treatment Guidelines [Internet].2021.https:\/\/www.cdc.gov\/std\/treatment\u2010guidelines\/pid.htm"},{"key":"e_1_2_11_6_1","unstructured":"RossJ EvansC LyonsD DeanG CousinsD.United Kingdom National Guideline for the Management of Pelvic Inflammatory Disease [Internet]. Accessed August 18 2023.2018.https:\/\/www.bashhguidelines.org"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jmig.2019.04.027"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1080\/01443615.2020.1867965"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1155\/2016\/5120293"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2019.05.004"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1155\/2019\/4161394"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jmig.2022.01.004"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00404-020-05640-0"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2021.01.011"},{"key":"e_1_2_11_15_1","unstructured":"Counties Manukau Health.Annual Report 2021\/22. Auckland.2021https:\/\/www.tewhatuora.govt.nz\/assets\/Uploads\/Annual\u2010Report\u20102021\u201022\u2010Counties\u2010Manukau.pdf"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/tog.12447"},{"issue":"2","key":"e_1_2_11_17_1","first-page":"1115","article-title":"Clinical value of early laparoscopic therapy in the management of tubo\u2010ovarian or pelvic abscess","volume":"18","author":"Jiang X","year":"2019","journal-title":"Exp Ther Med"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1186\/s10397-021-01095-6"},{"key":"e_1_2_11_19_1","first-page":"30","article-title":"Overweight and obesity prevalence among adult Pacific peoples and Europeans in the diabetes heart and health study (DHAHS) 2002\u20132003, Auckland New Zealand","volume":"123","author":"Sundborn G","year":"2010","journal-title":"N Z Med J"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm8070953"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0196-6553(00)90006-3"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1038\/ijo.2012.62"},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.1097\/OGX.0b013e3181b8b0d6"}],"container-title":["International Journal of Gynecology &amp; Obstetrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ijgo.70100","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/ijgo.70100","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ijgo.70100","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T07:51:51Z","timestamp":1771314711000},"score":1,"resource":{"primary":{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/10.1002\/ijgo.70100"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,31]]},"references-count":22,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2025,8]]}},"alternative-id":["10.1002\/ijgo.70100"],"URL":"https:\/\/doi.org\/10.1002\/ijgo.70100","archive":["Portico"],"relation":{},"ISSN":["0020-7292","1879-3479"],"issn-type":[{"value":"0020-7292","type":"print"},{"value":"1879-3479","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,31]]},"assertion":[{"value":"2024-10-06","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-03-12","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-03-31","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}