Clinical Impression Lacks Accuracy for Diagnosing Spontaneous Bacterial Peritonitis

Ascites requiring paracentesis is a relatively common emergency department presentation. The incidence of spontaneous bacterial peritonitis (SBP) in asymptomatic outpatients undergoing large-volume paracentesis is relatively low (2.5%) compared with the incidence in inpatient populations (12% to 18%). In a prospective observational study, researchers evaluated the accuracy of physicians’ clinical impressions for diagnosing SBP in 144 adult patients with ascites who presented to three EDs and were considered by the attending physician to require paracentesis and peritoneal fluid analysis. Patients were evaluated independently by two different physicians before undergoing paracentesis. Clinicians recorded clinical impressions, results of flui…