Ever been annoyed when you try to admit a liver patient and the MAR requests that you perform a diagnostic tap prior to admission? Here is the data behind why we perform diagnostic paracentesis in the ED.

Bottom line: performing diagnostic paracentesis in hospitalized patients early is associated with improved mortality. 

There are a few important facts to know about SBP.

Classic symptoms include: fever, abdominal pain, altered mental status, abdominal tenderness, worsening ascites and hypotension.

Only 25-40% of patients with SBP have symptoms. 

About 12% of patients with cirrhosis admitted to the hospital have SBP.

Mortality from SBP is about 40%.

Diagnostic tap is associated with lower in-hospital mortality: A review of 17,711 patients with cirrhosis and ascites who were admitted to the hospital with a primary diagnosis of ascites or encephalopathy showed that 61% had diagnostic tap and those with diagnostic tap had a lower in-hospital mortality rate than those who did not undergo paracentesis (6.5 versus 8.5 percent; adjusted odds ratio 0.55, 95% CI 0.41-0.74).

How to do a diagnostic paracentesis? Check out Jackie’s post: https://sinaiem.org/paracentesis-checklist/

Want to read more?

Chinnock B, et al. Clinical impression and ascites appearance do not rule out bacterial peritonitis. Emerg Med. 2013 May;44(5):903-9. Epub 2013 Mar 7.

Orman ES, et al. Paracentesis is associated with reduced mortality in patients hospitalized with cirrhosis and ascites. Clin Gastroenterol Hepatol. 2014;12(3):496. Epub 2013 Aug 24.