PLANNED dossier — no manifest, package, or design brief on disk yet. Time-critical pathway: gyn within 2 h, OR within hours; preserve ovary even if dusky per ACOG 783; preserved Doppler flow does NOT rule out torsion. Drug regimen captures perioperative supportive care (IV crystalloid, ondansetron, morphine/fentanyl, acetaminophen, ketorolac), conditional antibiotic prophylaxis if infection suspected, and post-op multimodal analgesia + VTE prophylaxis. Pediatric population explicitly included; oophoropexy considered for recurrent torsion only. GAPS — no RxCUIs (validate via npm run research:rxnav:validate); registry lacks ovarian-torsion-specific workup adapter (uses workup.pelvic_pain); no test_files; no torsion-specific risk score in registry; LOINC list empty. Deepened 2026-05-14 (shard-5-obped-id depth-pass-1): added co-located _briefs/gyn.ovarian-torsion.v1.depth.md companion brief (non-.depth. slot held by 2026-04-27 Playbook-0.5 brief) + _research-bundles/gyn.ovarian-torsion.v1.md. design_brief pointer repointed to the new .depth.md companion (in-scope per shard contract). 8-axis phenotype matrix surfaced (age-band: premenarchal/adolescent/reproductive-age/pregnant/postmenopausal × adnexal-mass-present yes/no × anatomic-substrate ovary-only/ovary-and-tube/paratubal-cyst/tube-only × duration <6h-ideal/6-24h-marginal/>24h-non-viable × pattern intermittent/sustained × concurrent-pregnancy non-pregnant/first-tri/IVF/corpus-luteum × prior-history no-prior/prior-unilateral-~10%-recurrence/prior-bilateral × tissue-tier hemorrhagic/ischemic/gangrenous). First-class TS field for phenotype matrix remains schema-blocked. Added new outpatient setting playbook (third playbook in setting_playbooks[]) covering post-detorsion gyn follow-up at 1-2 wk + 6 wk (wound check, pathology review confirmation, psychosocial screen, oophoropexy decision), 3-month pelvic ultrasound if ovary preserved (viability + perfusion + follicular activity), FSH + estradiol at 3 months if symptomatic (ovarian function assessment), fertility counseling (especially if oophorectomy required OR younger patient OR bilateral pathology — REI referral if concerning markers), contraception OR fertility-preservation discussion (LARC / combined OC / barrier aligned with reproductive plan), oophoropexy consideration if recurrent torsion OR large adnexal mass remaining OR pediatric / adolescent normal-ovary torsion at index event, psychosocial recovery + future-pregnancy anxiety (heightened in pediatric and post-IVF subgroups), and future-pregnancy counseling (early TVUS at next pregnancy due to ~ 5-10 % recurrence-on-contralateral-ovary risk; torsion-recognition symptoms during pregnancy). Added 'outpatient' to settings[] framing list. Added 2 new severity_triggers: delayed_or_after_confirmation (severe — > 6 h confirmed-torsion to OR → salvage drops to < 30 % beyond 24 h; gyn-on-call emergent escalation + detorsion still recommended per Oelsner 2003) and bilateral_torsion_simultaneous (life-threatening — rare but severe fertility consequence; emergent OR + bilateral detorsion + bilateral oophoropexy + REI consultation for fertility-preservation counseling). Existing 7 severity_triggers preserved (high_clinical_suspicion_normal_doppler, peritonitic_findings_or_instability, pediatric_torsion, pregnancy_with_torsion, recurrent_torsion, suspected_malignancy, OHSS_overlap). Final severity-trigger count: 9 rows. Appended 4 canonical PMIDs — Oelsner 2003 Hum Reprod (PMID 14645177; foundational detorsion-first); Bouguizane 2003 J Gynecol Obstet Biol Reprod (PMID 14593299); Anders 2005 Arch Pediatr Adolesc Med (PMID 15939851; pediatric preservation); Vijayaraghavan 2004 J Ultrasound Med (PMID 15557307; whirlpool sign). All flagged NEEDS_SOURCE_REVIEW if local PubMed mirror cannot resolve. Brings evidence.pmids from 3 to 7 entries. Bayesian linkage (documented in co-located _briefs/gyn.ovarian-torsion.v1.depth.md): pre-test priors per ACR + ACOG CO 783 + NASPAG 2020 (reproductive-age pelvic pain in ED ≈ 2.7 % overall, ≈ 15 % if known adnexal mass > 5 cm OR sudden severe unilateral pain + vomiting; pediatric / adolescent acute pelvic pain ≈ 4-6 %; IVF cycle ≈ 0.2 %, ≈ 7 % in OHSS-associated enlarged-ovary states; prior ipsilateral torsion → recurrence ≈ 10 %; postmenopausal complex mass — malignancy is dominant prior). LR data: TVUS whirlpool sign LR+ > 20-50 (essentially pathognomonic when seen by experienced operator); Doppler absent arterial flow LR+ ≈ 10-15 (specificity high, sensitivity ≈ 50-70 % due to dual blood supply — absence does NOT rule out torsion, false-negative US ≈ 25-30 %); Doppler absent venous flow LR+ ≈ 4-6 (precedes arterial loss); CT enlarged-adnexa + free fluid + smooth-wall thickening LR+ ≈ 5-7; MRI most sensitive overall (LR+ ≈ 10-15 — reserved for equivocal cases in pregnancy or pediatrics to avoid CT radiation); clinical features pivot priors (sudden severe unilateral pelvic pain + vomiting + young female with mass → combined LR+ ≈ 8-12; without mass — pediatric normal-ovary pattern → combined LR+ ≈ 4-6). Decision thresholds: T_treat = OR for laparoscopic exploration at clinical pre-test ≥ ~20 % even with negative imaging (high regret cost of 6-h-delay → ovary loss; false-positive laparoscopy recoverable); T_treat = OR within 2 h of imaging-positive diagnosis (salvage by duration: < 6 h ≈ > 90 %, 6-24 h ≈ 50-70 %, > 24 h ≈ 30 %); T_test = post-test < 5 % + alternative diagnosis identified + normal Doppler + no mass + reliable for return = discharge with safety-net follow-up; T_treat = detorsion as default regardless of gross appearance (Oelsner 2003 + Bouguizane 2003 + Anders 2005 binding; oophorectomy only for unequivocal tissue disintegration OR imaging/histology-confirmed malignancy); T_treat = oophoropexy at this OR for recurrent torsion OR pediatric normal-ovary torsion OR bilateral torsion. Cross-dossier routing: ob.ectopic-pregnancy.v1 (β-hCG before imaging — always check first in reproductive-age; if positive, route ectopic-first), gi.acute-appendicitis.core.v1 (RLQ pain + negative β-hCG + fever/leukocytosis/migration — both may need workup in pre-pubertal girls), uro.testicular-torsion.v1 (male-equivalent emergency — always exam genitalia in pediatric pelvic pain per NASPAG 2020), and ob.postpartum-hemorrhage.core.v1 (intra-op massive bleeding overlay for ruptured hemorrhagic cyst + torsion + hemoperitoneum — off-label MTP-1:1:1 reasonable adjunct). Prehospital recognition state-of-play: encoded via severity_triggers[].fires (setting:OR_now in peritonitic_findings_or_instability, delayed_or_after_confirmation, and bilateral_torsion_simultaneous rows) + ED escalation_triggers; a first-class 'prehospital' DossierSetting value is schema-blocked. EMS pattern: recognise acute pelvic pain + syncope + vomiting in reproductive-age or pediatric female → large-bore IV × 1-2, pre-notify ED + gyn-on-call, permissive analgesia (opioid titrated to effect + antiemetic), do NOT delay transport for imaging or extended analgesia titration. Detorsion-vs-oophorectomy current consensus encoded in flow.phases[TREATMENT].purpose + severity_triggers[delayed_or_after_confirmation].fires + severity_triggers[bilateral_torsion_simultaneous].fires — modern standard of care is detorsion as default regardless of gross appearance (Oelsner 2003; Bouguizane 2003; Anders 2005; Mage 2005; AAP / NASPAG 2020). Historical "if it looks black, take it out" practice is an active deviation. Oophorectomy reserved for: (1) unequivocal tissue disintegration / friable necrosis at exploration (rare even after > 24 h); (2) suspected malignancy on imaging or intra-op frozen-section — gyn-onc-directed; (3) patient preference after counseling in completed-childbearing scenario with complex pathology; (4) bilateral grossly necrotic disintegration after prolonged torsion (still rare). Removed 2026-05-26: DELIVER 36027571 / POINT 29766750 / REDUCE 23900119 PMIDs were copy-paste-template carryover from 2026-04-27 baseline — none are torsion-specific trials — removed per the orchestrator-gated audit (docs/superpowers/notes/2026-05-26-citation-deep-audit.md).