Observer variation and accuracy in the clinical diagnosis of ascites

: Seventeen observers participated in an observer variation study of the clinical evaluation of ascites. In a blinded design, eight patients with diagnoses of liver disease were examined. Fourteen observers examined the patients twice in order also to estimate the intra-observer variation. The accuracy of the observers' statements was compared with ultrasound findings, by which mean ascites was demonstrated in two patients. Poor correspondance between the observers' gradings and volume estimations, and poor accuracy of the gradings, make qualitative and quantitative ascites estimations useless. The inter-observer agreement was found to be low although the intra-observer agreement was good. The observers' subjective certainty of correctness of their own findings, marked as certain/uncertain, did not reflect the chance of making a correct statement on each particular occasion. The individual patient's general ability of inducing certainty did relate the chance of forming a correct diagnosis. Ultrasonic investigation of the abdomen is recommended in all situations in which demonstration of ascites is essential to diagnosis or therapy.