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A simple bedside manoeuvre to detect ascites

D S Chongtham1, M M Singh, S P Kalantri

  • 1Postgraduate Institute of Medical Education and Research, Chandigarh, India.

The National Medical Journal of India
|January 1, 1997
PubMed
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Auscultatory percussion is more sensitive than the puddle sign for detecting ascites, offering a valuable bedside diagnostic tool when advanced imaging is unavailable. This study compared these physical examination techniques for ascites diagnosis.

Area of Science:

  • Clinical Medicine
  • Diagnostic Techniques
  • Gastroenterology

Background:

  • Traditional physical examination methods like shifting dullness and fluid wave may not detect moderate or minimal ascites.
  • Ultrasonography is effective for ascites detection but often inaccessible in rural India.
  • The study evaluated alternative bedside diagnostic methods for ascites.

Purpose of the Study:

  • To assess the diagnostic utility of the puddle sign and auscultatory percussion for detecting ascites.
  • To compare the sensitivity and specificity of these two physical examination techniques against ultrasonography.
  • To identify a reliable bedside method for ascites diagnosis in resource-limited settings.

Main Methods:

  • A study involving 66 patients with suspected ascites.

Related Experiment Videos

  • Exclusion criteria included prior ascites history or therapeutic paracentesis.
  • The puddle sign and auscultatory percussion were performed, with ultrasonography as the gold standard; investigators were blinded to findings.

    • Main Results:

    • Auscultatory percussion demonstrated significantly higher sensitivity (65.7%) compared to the puddle sign (45%).
    • The puddle sign exhibited higher specificity (67.7%) than auscultatory percussion (48.4%).
    • No significant differences were found in predictive values or likelihood ratios between the two methods.

    Conclusions:

    • Auscultatory percussion is a more sensitive method for detecting ascites than the puddle sign.
    • The increased sensitivity of auscultatory percussion makes it a preferable bedside technique for ascites diagnosis.
    • These findings support the use of auscultatory percussion in clinical settings where ultrasonography is not readily available.