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48 Time to tap? an audit of diagnostic paracentesis in inpatients with cirrhosis at a university teaching hospital
  1. S O’Brien,
  2. S O’Hanlon,
  3. O El Sherif,
  4. S McKiernan,
  5. M Iqbal
  1. Gastroenterology/Hepatology Department, St. James Hospital, Dublin 8, Ireland

Abstract

Background Spontaneous bacterial peritonitis (SBP) is a diagnosis associated with significant mortality. It has previously been shown that delayed paracentesis is associated with increased inpatient mortality in patients with SBP.

Aim The aim of this audit was to identify time elapsed between patient presentation and the performance of diagnostic paracentesis at a University teaching hospital.

Method We included all patients who presented to the emergency department with ascites in the setting of cirrhosis and who had a diagnostic paracentesis. In all, 122 patients over 12 months were included in our study. Data was collected retrospectively from electronic patient records. Samples were categorised according to 3 time ranges:<12 hours, 12-24 hours, >24 hours.

Results Time to paracentesis is outlined in Table 1. 29.5% of patients didn’t have a white cell count sent as part of their ascites tap. 13 of the 86 patients (15.1%) with WCC sent were diagnosed with SBP, 5 of these were diagnosed >24 hours after presentation. Mortality was higher in patients whose diagnostic paracentesis were delayed until >24 hours after presentation (3/5) compared to those with paracentesis performed at <24 hours (1/9). p=0.052.

Abstract 48 Table 1

Conclusions A significant number of patients experienced delayed paracentesis. Recommendation: Education of NCHDs in the importance of diagnostic paracentesis to guide management and reduce mortality. Further training in the skill of performing paracentesis. Re-audit following these proposals.

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