Chongtham D S, Singh M M, Kalantri S P, Pathak S, Jain A P
Department of Medicine, Mahatma Gandhi Institute of Medical Sciences, Sevagram, Wardha, India.
Indian J Med Sci. 1998 Nov;52(11):514-20.
A study was conducted to assess the clinical accuracy of various clinical manoeuvres and signs used routinely for detection of ascites. Sixty-six patients admitted in medical ward of a teaching hospital after initial screening by a consultant were selected. Exclusion criteria were; cases with previous history of ascites, who had undergone paracentesis in the recent past or with evidence of ascites from history. Another clinician blind to history and clinical details assessed the presence of ascites by the selected methods a sonographer blind of clinical and historical details assessed the cases for presence of ascitic fluid. The clinical findings were compared using ultrasonographic (USG) findings as gold standard. Ascites was detected in 35 patients by USG. the mean weight and abdominal girth of study subjects with or without ascites were comparable (p > 0.05). Sensitivity of auscultatory percussion was highest (65.7%) followed by flank dullness (57.1%) and least for fluid wave sign (20.0%). Fluid wave sign had the highest specificity (100%). We found that none of the manoeuvres studied for detection of ascites was both highly sensitive and specific. However, auscultatory percussion could be useful for initial screening of patients to detect ascites.
一项研究旨在评估常规用于检测腹水的各种临床操作和体征的临床准确性。在一家教学医院的内科病房，经过一名顾问的初步筛查后，选取了66名患者。排除标准为：有腹水既往史的病例、近期接受过腹腔穿刺术的病例或根据病史有腹水证据的病例。另一名对病史和临床细节不知情的临床医生通过选定的方法评估腹水的存在，一名对临床和病史细节不知情的超声检查医师对病例进行腹水检测。以超声检查（USG）结果作为金标准，比较临床检查结果。通过超声检查在35名患者中检测到腹水。有或无腹水的研究对象的平均体重和腹围具有可比性（p>0.05）。听诊叩诊的敏感性最高（65.7%），其次是侧腹浊音（57.1%），液波震颤的敏感性最低（20.0%）。液波震颤的特异性最高（100%）。我们发现，所研究的用于检测腹水的操作中，没有一种既具有高敏感性又具有高特异性。然而，听诊叩诊可用于对患者进行初步筛查以检测腹水。
