Physician clinical impression does not rule out spontaneous bacterial peritonitis in patients undergoing emergency department paracentesis

Annals of Emergency Medicine
Brian ChinnockGregory W Hendey

Abstract

We determine whether clinical characteristics and physician assessment are useful in the exclusion of spontaneous bacterial peritonitis in emergency department (ED) patients with ascites requiring paracentesis. We conducted a prospective, observational study of ED patients with ascites undergoing paracentesis. Predefined clinical characteristics including historical features and ED vital signs were recorded. Each patient was assessed by 2 separate, blinded physicians for severity of abdominal tenderness and overall clinical suspicion for spontaneous bacterial peritonitis. The primary outcome measures were sensitivity, specificity, and likelihood ratios (LR) of the individual clinical characteristics and the physician assessments. Spontaneous bacterial peritonitis was defined by absolute neutrophil count greater than 250 cells/mm(3) or positive fluid culture result. There were 285 separate physician assessments in 144 patients enrolled with complete data. Spontaneous bacterial peritonitis was diagnosed in 17 (11.8%) patients. Physician clinical impression had a sensitivity of 76% (95% confidence interval [CI] 62% to 91%) and specificity of 34% (95% CI 28% to 40%) for the detection of spontaneous bacterial peritonitis. The lowest...Continue Reading

References

Oct 1, 1990·Hepatology : Official Journal of the American Association for the Study of Liver Diseases·B A Runyon
Mar 1, 1995·Digestive Diseases and Sciences·C M ChuY F Liaw
Jan 19, 2000·The American Journal of Gastroenterology·R K DhimanY Chawla
Apr 17, 2001·Digestive and Liver Disease : Official Journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver·M BorzioA Sangiovanni
May 22, 2002·European Journal of Internal Medicine·Anastasia C. ThanopoulouStephanos J. Hadziyannis
Apr 2, 2003·Hepatology : Official Journal of the American Association for the Study of Liver Diseases·Luke T EvansPatrick S Kamath
Jan 1, 2005·East African Medical Journal·L Filik, S Unal
Oct 9, 2007·The American Journal of Emergency Medicine·Brian Chinnock, Gregory W Hendey

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Citations

Oct 12, 2011·Indian Journal of Gastroenterology : Official Journal of the Indian Society of Gastroenterology·Varghese Thomas
Oct 29, 2013·Best Practice & Research. Clinical Gastroenterology·Nicole Ming-Ming LooGuadalupe Garcia-Tsao
Feb 6, 2013·World Journal of Hepatology·Maria PleguezueloManuel De la Mata
Aug 19, 2014·International Journal of Hepatology·Hirayuki EnomotoShuhei Nishiguchi
Jul 7, 2012·The Journal of Emergency Medicine·Mai ShimadaDavid A Tanen
Feb 11, 2014·Clinica Chimica Acta; International Journal of Clinical Chemistry·Giuseppe LippiMartina Montagnana
Nov 1, 2016·Hepatitis Monthly·Gholamreza KalvandiHazhir Javaherizadeh
Sep 14, 2016·The American Journal of Gastroenterology·Thierry ThévenotUNKNOWN CFEHTP, ANGH and the PerDRISLA study group
Aug 3, 2016·Journal of Pediatric Gastroenterology and Nutrition·Anshu SrivastavaUjjal Poddar
Aug 8, 2018·Hepatology Research : the Official Journal of the Japan Society of Hepatology·Delphine WeilThierry Thévenot
Apr 14, 2019·Current Treatment Options in Gastroenterology·Sirina Ekpanyapong, K Rajender Reddy
Nov 7, 2019·The American Journal of Gastroenterology·Russell RosenblattArun Jesudian
Feb 22, 2011·Critical Care Medicine·Ali Al-Khafaji, David T Huang
May 5, 2020·Biomarkers : Biochemical Indicators of Exposure, Response, and Susceptibility to Chemicals·Xianmei WuTao Luo
Oct 24, 2014·World Journal of Gastroenterology : WJG·Angelo Alves de MattosCristiane Valle Tovo
Mar 11, 2016·World Journal of Hepatology·Chalermrat BunchorntavakulDisaya Chavalitdhamrong
Dec 5, 2020·Digestive Diseases and Sciences·Backer AbduMarc Piper
Jun 29, 2021·Romanian Journal of Internal Medicine = Revue Roumaine De Médecine Interne·Roxana-Emanuela Popoiag, Carmen Fierbințeanu-Braticevici
Aug 5, 2021·Journal of Hospital Medicine : an Official Publication of the Society of Hospital Medicine·Evan RitterRehan Qayyum

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