Abstract
The authors prospectively evaluated the operating characteristics of the history and physical examination for ascites in a broad spectrum of hospitalized patients. The overall clinical evaluation produced a positive likelihood ratio = 37.7−83.3 when suggestive of ascites, a likelihood ratio = 2.23−3.42 when intermediate, and a negative likelihood ratio = 0.77 − 0.90 when not suggestive of ascites. Patients’ perceptions of increased abdominal girth (positive likelihood ratio = 4.16) or recent weight gain (positive likelihood ratio = 3.20) increased the likelihood of ascites. The absence of subjective ankle swelling (negative likelihood ratio = 0.10) or increased abdominal girth (negative likelihood ratio = 0.17) decreased the likelihood of ascites. The positive likelihood ratios for a fluid wave = 9.6 and shifting dullness = 5.76 favored ascites, while the absence of bulging flanks (negative likelihood ratio = 0.12) or peripheral edema (negative likelihood ratio = 0.17) favored ascites the least. Thus, a routine history and physical examination are quantitatively useful in the clinical evaluation of ascites.
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Supported in part by the A. W. Mellon Foundation.
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Simel, D.L., Halvorsen, R.A. & Feussner, J.R. Quantitating bedside diagnosis. J Gen Intern Med 3, 423–428 (1988). https://doi.org/10.1007/BF02595917
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DOI: https://doi.org/10.1007/BF02595917