title: Pocket ultrasound device as a complement to physical examination for ascites evaluation and guided paracentesis.
abstract: The pocket ultrasound device (PUD) is a new tool that may be of use in the early detection of ascites. Abdominal ultrasound-guided paracentesis has been reported to decrease the rate of complications due to the procedure, but must be performed in a healthcare setting; this new tool may be a useful on an ambulatory basis. The aim of this study was to determine the diagnostic usefulness of the PUD in the diagnosis of ascites and the safety of guided paracentesis. We conducted a retrospective study that included adult patients suspected of having ascites and in whom an evaluation was performed with the PUD to identify it. Concordance with abdominal ultrasound (AUS) was determined with the Kappa coefficient. Sensitivity (Se), specificity (Sp) and likelihood ratios (LR) were determined and compared with physical examination, AUS, computed tomography and procurement of fluid by paracentesis. Complications resulting from the guided paracentesis were analyzed. 89 participants were included and 40 underwent a paracentesis. The PUD for ascites detection had 95.8 % Se, 81.8 % Sp, 5.27 +LR and 0.05 -LR. It had a concordance with AUS of 0.781 (p < 0.001). Technical problems during the guided paracentesis were present in only two participants (5 %) and three patients (7.5 %) developed minor complications that required no further intervention. There were no severe complications or deaths. This study suggests that the PUD is a reliable tool for ascites detection as a complement to physical examination and appears to be a safe method to perform guided paracentesis.
authors.affiliation: Department of Gastroenterology, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Vasco de Quiroga 15, Sección XVI, Tlalpan, 14000, Mexico City, Mexico.
authors.forename: Daniel
authors.initials: D
authors.lastname: Keil-Ríos
authors.affiliation: Department of Internal Medicine, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico.
authors.forename: Hiram
authors.initials: H
authors.lastname: Terrazas-Solís
authors.affiliation: Department of Research Methodology, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico.
authors.forename: Alejandro
authors.initials: A
authors.lastname: González-Garay
authors.affiliation: Department of Gastroenterology, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Vasco de Quiroga 15, Sección XVI, Tlalpan, 14000, Mexico City, Mexico.
authors.forename: Juan Francisco
authors.initials: JF
authors.lastname: Sánchez-Ávila
authors.affiliation: Department of Gastroenterology, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Vasco de Quiroga 15, Sección XVI, Tlalpan, 14000, Mexico City, Mexico. drinter77@gmail.com.
authors.forename: Ignacio
authors.initials: I
authors.lastname: García-Juárez
mesh_terms: D000328:Adult; D000368:Aged; D001201:Ascites / Q000175:diagnosis* / Q000628:therapy; D015331:Cohort Studies; D004635:Emergency Medicine / Q000379:methods; D004638:Emergency Treatment; D004867:Equipment Design; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019152:Paracentesis / Q000295:instrumentation / Q000379:methods*; D061214:Patient Safety; D010808:Physical Examination / Q000295:instrumentation / Q000379:methods*; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000295:instrumentation*
keywords: Ascites; Handheld; Paracentesis; Pocket; Ultrasound