Association of CT findings in patients with hemoperitoneum due to ruptured ovarian cysts with subsequent intervention.

PURPOSE: Hemoperitoneum caused by ovarian cyst rupture may necessitate intervention. The literature is lacking in descriptions of CT findings that help guide patient management. The purpose of this study is to consider CT findings associated with a need for intervention (surgical or interventional radiology management) versus conservative treatment (observation, pain management, and blood transfusions). METHODS: Two radiologists retrospectively and independently reviewed 103 CTs of pre-menopausal women who presented with acute hemoperitoneum related to ruptured ovarian cysts between January 2010 and January 2019. The following imaging features were assessed: ovarian cyst characteristics, sentinel clot, contrast extravasation, and hemoperitoneum size. Findings were correlated with patient demographics, clinical parameters, and management with surgery/interventional radiology procedure (intervention group) versus conservative management (conservative group). RESULTS: Of the 103 patients with hemoperitoneum from cyst rupture, 16% (n = 16) required intervention, and 84% underwent conservative treatment (n = 87). Length of stay (p = .008) was higher in the intervention group. Statistically significant CT findings in the intervention versus conservative group included (p-value reader 1/p-value reader 2) greatest AP dimension of hemoperitoneum (p = .001/p = 0.02), posterior cul-de-sac AP dimension (p = 0.03/p = .006), total cul-de-sac AP dimension (p = .002/p = .007), and number of spaces with hemoperitoneum (p = .01/p = .02). There was good to excellent inter-reader agreement for these findings (ICC 0.68-0.91). Active contrast extravasation was significant for one reader (p = .02) with poor inter-reader agreement (ICC 0.36). In utilizing ROC curves, thresholds of 107 mm (greatest axial AP dimension of hemoperitoneum) yielded a sensitivity and specificity of 0.81 and 0.62 for reader 1 and 0.69 and 0.55 for reader 2; 45 mm (posterior cul-de-sac AP dimension) yielded a sensitivity and specificity of 0.75 and 0.63 for reader 1 and 0.94 and 0.49 for reader 2; 70 mm (total cul-de-sac AP dimension) yielded a sensitivity and specificity of 0.75 and 0.64 for reader 1 and 0.75 and 0.50 for reader 2; and greater than 5 spaces yielded a sensitivity and specificity of 0.75 and 0.58 for reader 1 and 0.69 and 0.70 for reader 2. CONCLUSION: CT findings associated with intervention in hemoperitoneum due to ovarian cyst rupture include size of hemoperitoneum, number of abdominopelvic spaces with hemoperitoneum, and contrast extravasation.

Characteristics of Early Recipients of Patient-Centered Outcomes Research Institute Funding.

The Patient Protection and Affordable Care Act (ACA) is grounded in the goals of increasing access, improving quality, and reducing cost in the U.S. health care system. The ACA established the Patient-Centered Outcomes Research Institute (PCORI) to help accomplish these goals through patient-focused research. PCORI has a different charge than its federally supported counterpart, the National Institutes of Health (NIH)-to fund research that ultimately helps patients make better-informed health care decisions. The authors examined characteristics of the recipients and settings of the first six rounds of PCORI funding and differentiated PCORI and NIH funding patterns to analyze the extent to which PCORI is accomplishing the goals set out by the ACA. The authors performed a retrospective review of publicly available datasets, supplemented by a short questionnaire to funded PCORI principal investigators (PIs). The authors analyzed PCORI's first six funding cycles (2011-2014) and data on NIH funding patterns (2000-2013) to determine whether PCORI and NIH funding patterns differed by investigator, department, and institution, and whether PCORI had funded research in primary care settings. The authors found that PCORI is funding a more diverse cadre of PIs and biomedical departments than is NIH, but not a greater diversity of institutions, and that less than one-third of PCORI studies involve or are relevant to primary care--the largest patient care platform in the United States. As PCORI looks to be refunded, it is important that research funding is further evaluated and publicly acknowledged to assess whether goals are being achieved.