Journal of General Internal Medicine

, Volume 3, Issue 5, pp 423–428 | Cite as

Quantitating bedside diagnosis

Clinical evaluation of ascites
  • David L. Simel
  • Robert A. HalvorsenJr.
  • John R. Feussner
Original Articles


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.

Key words

clinical diagnosis ascites bias 


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Copyright information

© the Society of General Internal Medicine 1988

Authors and Affiliations

  • David L. Simel
    • 1
  • Robert A. HalvorsenJr.
    • 2
  • John R. Feussner
    • 1
  1. 1.the Health Services Research Field Program, Durham Veterans’ Administration Medical Center, Division of General Internal MedicineDuke University Medical CenterDurham
  2. 2.the Department of RadiologyDurham Veterans’ Administration Medical CenterUSA

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