Quantitating bedside diagnosis

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. Presented at the meeting of the Southern Section of the Society for Research and Education in Primary Care Internal Medicine, New Orleans, LA, February 6–8, 1986. Supported in part by the A. W. Mellon Foundation.