Take Pride in the Para

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    Take Pride in the Para

    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.

    https://journals.lww.com/em-news/Fulltext/2018/05000/What_to_D_O___Is_Paracentesis_for_All_Admitted.8.aspx

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