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un estudio observacional retrospectivo en un centro dotado de 3 consultas monogr&#225;ficas semanales agendadas de ecograf&#237;a y una agenda adicional semanal para estudios ecogr&#225;ficos y procedimientos no programados&#46; Todos los estudios ecogr&#225;ficos son realizados por o bajo la supervisi&#243;n de 2 reumat&#243;logos expertos en ER&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Se incluyeron todos los registros de estudios realizados entre marzo y diciembre de 2022&#44; tanto los programados como los realizados a demanda con excepci&#243;n de aquellos realizados en el contexto de otros estudios protocolizados&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">A partir de las historias cl&#237;nicas electr&#243;nicas&#44; se recogieron datos relacionados con los tiempos de espera&#44; indicaci&#243;n de la prueba&#44; concordancia del resultado con la sospecha cl&#237;nica e impacto del resultado en la decisi&#243;n tomada en consulta&#46; El impacto sobre la conducta cl&#237;nica se consider&#243; positivo s&#243;lo si se constat&#243; expresamente en la historia cl&#237;nica una participaci&#243;n del resultado ecogr&#225;fico en la toma de decisiones&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">En este estudio no se han entrevistado ni realizado procedimientos con pacientes&#46; Para la revisi&#243;n de historias cl&#237;nicas se obtuvo la aprobaci&#243;n de nuestro comit&#233; &#233;tico de investigaci&#243;n cient&#237;fica&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Resultados</span><p id="par0040" class="elsevierStylePara elsevierViewall">Se analizaron 801 solicitudes de ER&#46; En 355 de ellas se solicitaba la evaluaci&#243;n de m&#225;s de una regi&#243;n &#40;excluyendo GS&#44; GV&#44; IP&#41;&#46; El n&#250;mero de ecograf&#237;as individuales analizadas fue 1174&#44; de las que 165 fueron realizadas a demanda &#40;14&#37;&#41;&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Las indicaciones recogidas de las ER fueron&#58; prop&#243;sito de asistencia o confirmaci&#243;n diagn&#243;stica &#40;456&#44; 39&#37;&#41;&#44; evaluaci&#243;n de la actividad inflamatoria &#40;398&#44; 34&#37;&#41;&#44; realizaci&#243;n de procedimientos &#40;304&#44; 26&#37;&#41; y no identificado o sin indicaci&#243;n identificada &#40;168&#44; 14&#37;&#41;&#46; La <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a> resume la distribuci&#243;n topogr&#225;fica de los estudios realizados y los prop&#243;sitos de las indicaciones&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">En 376 de los 456 estudios diagn&#243;sticos &#40;asistencia o confirmaci&#243;n diagn&#243;stica&#41;&#44; se confirm&#243; la sospecha cl&#237;nica original &#40;82&#37;&#41;&#46; En 109 de ellos&#44; de confirmaci&#243;n diagn&#243;stica entre dos &#250;nicas posibilidades &#40;p&#46; ej&#46;&#44; artrosis vs&#46; artritis psori&#225;sica&#41;&#44; el estudio ecogr&#225;fico coincidi&#243; con la presunci&#243;n cl&#237;nica diagn&#243;stica en 97 casos y hubo discrepancias en 12 &#40;concordancia buena&#59; <span class="elsevierStyleItalic">kappa</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;748&#41;&#46; En 266 de los estudios de evaluaci&#243;n de actividad inflamatoria se constat&#243; modificaci&#243;n en la conducta cl&#237;nica &#40;67&#37;&#41;&#46; En el grupo de estudios diagn&#243;sticos&#44; 108 se realizaron bajo demanda&#44; el mismo d&#237;a de la solicitud y 268 bajo programaci&#243;n&#46; La proporci&#243;n de cambios en el manejo tras el resultado de la ecograf&#237;a se constat&#243; en 75 estudios a demanda &#40;69&#44;4&#37;&#41; y 156 estudios programados &#40;58&#44;2&#37;&#41; &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;042&#41;&#46; La <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a> muestra los tiempos de espera y el impacto del resultado en la toma de decisiones&#46; En general&#44; la media del tiempo de espera de los estudios que condicionaron un cambio en la decisi&#243;n cl&#237;nica fue menor que la de aquellos que no lo condicionaron&#46; Esta diferencia fue estad&#237;sticamente significativa en los estudios de carpo y mano &#40;61&#44;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>15&#44;4 vs&#46; 143&#44;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>68&#44;4 d&#237;as&#44; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; y tobillo y pie &#40;62<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>21&#44;1 vs&#46; 133<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>50&#44;1 d&#237;as&#44; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">De los 355 estudios con una solicitud de m&#225;s de un territorio&#44; 325 fueron de estudios bilaterales &#40;manos&#44; 293&#44; 82&#44;5&#37;&#41;&#46; Revisados los hallazgos observados se identific&#243; que en 261 estudios &#40;73&#44;5&#37;&#41;&#44; los hallazgos de un &#250;nico estudio &#40;unilateral&#41; aportaban informaci&#243;n cl&#237;nicamente relevante&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discusi&#243;n</span><p id="par0060" class="elsevierStylePara elsevierViewall">La ER contribuye a la toma de decisiones cl&#237;nicas y refrenda el criterio de sospecha diagn&#243;stica&#46; Adem&#225;s&#44; constatamos una importante demanda de procedimientos ecoguiados&#46; Por otro lado&#44; observamos que el mayor valor del resultado de las ER se obtiene de una evaluaci&#243;n r&#225;pida&#44; especialmente aquellas realizadas a demanda del cl&#237;nico&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">La principal limitaci&#243;n de nuestro estudio es su car&#225;cter unic&#233;ntrico&#44; aunque&#44; por otro lado&#44; nuestro servicio cuenta con una larga tradici&#243;n de escuela de ER y de ejercicio asistencial&#46; La mayor fortaleza radica en la gran cantidad de casu&#237;stica revisada que aporta una variada representaci&#243;n de todos los estudios ecogr&#225;ficos realizados en pr&#225;ctica cl&#237;nica&#44; excluyendo aquellos que se realizan en el contexto de estudios cient&#237;ficos&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Seg&#250;n nuestras observaciones&#44; los tiempos prolongados de espera reducen la utilidad cl&#237;nica de las ER&#46; En ese sentido&#44; convendr&#237;a plantear reducir la indicaci&#243;n de estudios bilaterales&#44; reservar un mayor espacio para los estudios a demanda y m&#225;s importante&#58; procurar la formaci&#243;n en ecograf&#237;a de todo el personal facultativo dotando adem&#225;s de m&#225;s equipos para realizar los estudios&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conclusi&#243;n</span><p id="par0075" class="elsevierStylePara elsevierViewall">La ER demuestra ser una t&#233;cnica &#250;til en la toma de decisiones complementando as&#237; la opini&#243;n cl&#237;nica&#46; El mayor impacto en la decisi&#243;n cl&#237;nica se identific&#243; en las ecograf&#237;as con menor tiempo de espera&#44; especialmente en los estudios de mano y pie&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Financiaci&#243;n</span><p id="par0080" class="elsevierStylePara elsevierViewall">Para la realizaci&#243;n del presente estudio no se ha recibido financiaci&#243;n interna ni externa&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conflicto de intereses</span><p id="par0085" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objetivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">El prop&#243;sito del presente estudio es identificar en qu&#233; medida la ecograf&#237;a reumatol&#243;gica afecta a las decisiones cl&#237;nicas mediante un estudio unic&#233;ntrico observacional retrospectivo&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">M&#233;todo</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Se analizaron los resultados de 801 solicitudes y 1174 ecograf&#237;as individuales consecutivas realizadas a lo largo de 10 meses&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">La indicaci&#243;n m&#225;s frecuente fue la asistencia diagn&#243;stica &#40;39&#37;&#41; seguida de la evaluaci&#243;n de actividad inflamatoria &#40;34&#37;&#41;&#46; Por topograf&#237;a&#44; la mano fue la regi&#243;n m&#225;s estudiada &#40;51&#37;&#41;&#44; seguida del pie &#40;18&#44;1&#37;&#41;&#46; De todas las solicitudes&#44; en el 67&#37; se constat&#243; un impacto en la toma de decisiones&#46; El impacto en la decisi&#243;n cl&#237;nica se asoci&#243; a un menor tiempo de espera hasta la evaluaci&#243;n de los resultados&#44; siendo el mayor en aquellas ecograf&#237;as realizadas a demanda el mismo d&#237;a de su petici&#243;n&#46; En el 73&#37; de los estudios ecogr&#225;ficos bilaterales&#44; los hallazgos en una de las articulaciones ejemplificaban el resultado global emitido&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La ecograf&#237;a reumatol&#243;gica demuestra ser una t&#233;cnica &#250;til en la toma de decisiones&#44; cuyo mayor impacto se constata cuanto menor es el tiempo de espera hasta la evaluaci&#243;n de los resultados&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objective</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">The purpose of the present study is to identify the extent to which rheumatological musculoskeletal ultrasound affects clinical decisions in a single-centre observational retrospective study&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Method</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">The results of 801 requests and 1174 consecutive individual ultrasound examinations performed over 10 months were analysed&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">The most frequent indication was diagnostic assistance &#40;39&#37;&#41; followed by assessment of inflammatory activity &#40;34&#37;&#41;&#46; By topography&#44; the hand was the most frequently studied region &#40;51&#37;&#41;&#44; followed by the foot &#40;18&#46;1&#37;&#41;&#46; Of all requests&#44; 67&#37; had an impact on decision-making&#46; The impact on clinical decision-making was associated with a shorter waiting time for the evaluation of the results&#44; being the greatest in those ultrasound scans performed on demand on the same day of the request&#46; In 73&#37; of bilateral ultrasound studies&#44; findings in one of the joints exemplified the overall result reported&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Rheumatological musculoskeletal ultrasound has proven to be a useful decision-making technique&#44; the greater the impact of which is seen the shorter the waiting time before it is performed&#46;</p></span>"
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                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Cambio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Sin cambio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="3" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Tiempos de espera</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Cambio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sin cambio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p-valor<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="8" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Ecograf&#237;as articulares</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Carpo y mano&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">59&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">52&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">61&#44;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>15&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">143<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>68&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Tobillo y pie&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">62<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>21&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">133<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>50&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hombro&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">114&#44;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>56&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">155<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>43&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;082&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Rodilla&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">124&#44;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>47&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">164&#44;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>40&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Codo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">72&#44;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>19&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">82&#44;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>23&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cadera&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">92&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="8" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="8" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Ecograf&#237;as extraarticulares</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Gl&#46; salivares&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">65&#44;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>24&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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Original breve
Utilidad de la ecografía reumatológica en la toma de decisiones en la práctica clínica: Estudio unicéntrico longitudinal
Usefulness of ultrasound in clinical decision-making in rheumatology clinical practice: A single-center longitudinal study
Marta Serrano-Warletaa, Aliuska Palomeque-Vargasa, Rosa Manzoa, Boris Blanco-Cáceresa,b, Mónica Vazquez-Díaza,b, Carlos Guillen-Astetea,b,
Autor para correspondencia
Carlosantonio.guillen@salud.madrid.org

Autor para correspondencia.
a Servicio de Reumatología, Hospital Universitario Ramón y Cajal, Madrid, España
b Unidad de Imagen y Procedimientos Ecoguiados, Hospital Universitario Ramón y Cajal, Madrid, España
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la experiencia formativa en ER ha sido valorada positivamente&#44; y a nivel nacional se estima que su uso ha mejorado significativamente la competencia y pr&#225;ctica cl&#237;nica del 71&#44;7&#37; de los reumat&#243;logos formados en esta t&#233;cnica<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a>&#46; As&#237; mismo&#44; en el manejo de patolog&#237;as agudas reumatol&#243;gicas en otros &#225;mbitos&#44; la ecograf&#237;a ha demostrado impacto en la experiencia percibida por el paciente<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">El prop&#243;sito del presente estudio es evaluar el impacto del uso de la ER en la toma de decisiones cl&#237;nicas y detectar &#225;reas de mejora&#44; campo sobre el que existe menos experiencia cient&#237;fica documentada&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">M&#233;todos</span><p id="par0020" class="elsevierStylePara elsevierViewall">Se dise&#241;&#243; un estudio observacional retrospectivo en un centro dotado de 3 consultas monogr&#225;ficas semanales agendadas de ecograf&#237;a y una agenda adicional semanal para estudios ecogr&#225;ficos y procedimientos no programados&#46; Todos los estudios ecogr&#225;ficos son realizados por o bajo la supervisi&#243;n de 2 reumat&#243;logos expertos en ER&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Se incluyeron todos los registros de estudios realizados entre marzo y diciembre de 2022&#44; tanto los programados como los realizados a demanda con excepci&#243;n de aquellos realizados en el contexto de otros estudios protocolizados&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">A partir de las historias cl&#237;nicas electr&#243;nicas&#44; se recogieron datos relacionados con los tiempos de espera&#44; indicaci&#243;n de la prueba&#44; concordancia del resultado con la sospecha cl&#237;nica e impacto del resultado en la decisi&#243;n tomada en consulta&#46; El impacto sobre la conducta cl&#237;nica se consider&#243; positivo s&#243;lo si se constat&#243; expresamente en la historia cl&#237;nica una participaci&#243;n del resultado ecogr&#225;fico en la toma de decisiones&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">En este estudio no se han entrevistado ni realizado procedimientos con pacientes&#46; Para la revisi&#243;n de historias cl&#237;nicas se obtuvo la aprobaci&#243;n de nuestro comit&#233; &#233;tico de investigaci&#243;n cient&#237;fica&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Resultados</span><p id="par0040" class="elsevierStylePara elsevierViewall">Se analizaron 801 solicitudes de ER&#46; En 355 de ellas se solicitaba la evaluaci&#243;n de m&#225;s de una regi&#243;n &#40;excluyendo GS&#44; GV&#44; IP&#41;&#46; El n&#250;mero de ecograf&#237;as individuales analizadas fue 1174&#44; de las que 165 fueron realizadas a demanda &#40;14&#37;&#41;&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Las indicaciones recogidas de las ER fueron&#58; 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con la presunci&#243;n cl&#237;nica diagn&#243;stica en 97 casos y hubo discrepancias en 12 &#40;concordancia buena&#59; <span class="elsevierStyleItalic">kappa</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;748&#41;&#46; En 266 de los estudios de evaluaci&#243;n de actividad inflamatoria se constat&#243; modificaci&#243;n en la conducta cl&#237;nica &#40;67&#37;&#41;&#46; En el grupo de estudios diagn&#243;sticos&#44; 108 se realizaron bajo demanda&#44; el mismo d&#237;a de la solicitud y 268 bajo programaci&#243;n&#46; La proporci&#243;n de cambios en el manejo tras el resultado de la ecograf&#237;a se constat&#243; en 75 estudios a demanda &#40;69&#44;4&#37;&#41; y 156 estudios programados &#40;58&#44;2&#37;&#41; &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;042&#41;&#46; La <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a> muestra los tiempos de espera y el impacto del resultado en la toma de decisiones&#46; En general&#44; la media del tiempo de espera de los estudios que condicionaron un cambio en la decisi&#243;n cl&#237;nica fue menor que la de aquellos que no lo condicionaron&#46; Esta diferencia fue estad&#237;sticamente significativa en los estudios de carpo y mano &#40;61&#44;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>15&#44;4 vs&#46; 143&#44;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>68&#44;4 d&#237;as&#44; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; y tobillo y pie &#40;62<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>21&#44;1 vs&#46; 133<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>50&#44;1 d&#237;as&#44; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">De los 355 estudios con una solicitud de m&#225;s de un territorio&#44; 325 fueron de estudios bilaterales &#40;manos&#44; 293&#44; 82&#44;5&#37;&#41;&#46; Revisados los hallazgos observados se identific&#243; que en 261 estudios &#40;73&#44;5&#37;&#41;&#44; los hallazgos de un &#250;nico estudio &#40;unilateral&#41; aportaban informaci&#243;n cl&#237;nicamente relevante&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discusi&#243;n</span><p id="par0060" class="elsevierStylePara elsevierViewall">La ER contribuye a la toma de decisiones cl&#237;nicas y refrenda el criterio de sospecha diagn&#243;stica&#46; Adem&#225;s&#44; constatamos una importante demanda de procedimientos ecoguiados&#46; Por otro lado&#44; observamos que el mayor valor del resultado de las ER se obtiene de una evaluaci&#243;n r&#225;pida&#44; especialmente aquellas realizadas a demanda del cl&#237;nico&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">La principal limitaci&#243;n de nuestro estudio es su car&#225;cter unic&#233;ntrico&#44; aunque&#44; por otro lado&#44; nuestro servicio cuenta con una larga tradici&#243;n de escuela de ER y de ejercicio asistencial&#46; La mayor fortaleza radica en la gran cantidad de casu&#237;stica revisada que aporta una variada representaci&#243;n de todos los estudios ecogr&#225;ficos realizados en pr&#225;ctica cl&#237;nica&#44; excluyendo aquellos que se realizan en el contexto de estudios cient&#237;ficos&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Seg&#250;n nuestras observaciones&#44; los tiempos prolongados de espera reducen la utilidad cl&#237;nica de las ER&#46; En ese sentido&#44; convendr&#237;a plantear reducir la indicaci&#243;n de estudios bilaterales&#44; reservar un mayor espacio para los estudios a demanda y m&#225;s importante&#58; procurar la formaci&#243;n en ecograf&#237;a de todo el personal facultativo dotando adem&#225;s de m&#225;s equipos para realizar los estudios&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conclusi&#243;n</span><p id="par0075" class="elsevierStylePara elsevierViewall">La ER demuestra ser una t&#233;cnica &#250;til en la toma de decisiones complementando as&#237; 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          "titulo" => "Abstract"
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          "titulo" => "Keywords"
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          "titulo" => "Introducci&#243;n"
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          "titulo" => "Conclusi&#243;n"
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          "identificador" => "sec0030"
          "titulo" => "Financiaci&#243;n"
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          "identificador" => "sec0035"
          "titulo" => "Conflicto de intereses"
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        11 => array:1 [
          "titulo" => "Bibliograf&#237;a"
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    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2023-08-01"
    "fechaAceptado" => "2023-09-15"
    "PalabrasClave" => array:2 [
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        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec1787826"
          "palabras" => array:3 [
            0 => "Ecograf&#237;a musculoesquel&#233;tica"
            1 => "Toma de decisiones"
            2 => "Pr&#225;ctica cl&#237;nica habitual"
          ]
        ]
      ]
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1787825"
          "palabras" => array:3 [
            0 => "Musculoskeletal ultrasound"
            1 => "Decision-making"
            2 => "Routine clinical practice"
          ]
        ]
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    "tieneResumen" => true
    "resumen" => array:2 [
      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objetivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">El prop&#243;sito del presente estudio es identificar en qu&#233; medida la ecograf&#237;a reumatol&#243;gica afecta a las decisiones cl&#237;nicas mediante un estudio unic&#233;ntrico observacional retrospectivo&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">M&#233;todo</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Se analizaron los resultados de 801 solicitudes y 1174 ecograf&#237;as individuales consecutivas realizadas a lo largo de 10 meses&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">La indicaci&#243;n m&#225;s frecuente fue la asistencia diagn&#243;stica &#40;39&#37;&#41; seguida de la evaluaci&#243;n de actividad inflamatoria &#40;34&#37;&#41;&#46; Por topograf&#237;a&#44; la mano fue la regi&#243;n m&#225;s estudiada &#40;51&#37;&#41;&#44; seguida del pie &#40;18&#44;1&#37;&#41;&#46; De todas las solicitudes&#44; en el 67&#37; se constat&#243; un impacto en la toma de decisiones&#46; El impacto en la decisi&#243;n cl&#237;nica se asoci&#243; a un menor tiempo de espera hasta la evaluaci&#243;n de los resultados&#44; siendo el mayor en aquellas ecograf&#237;as realizadas a demanda el mismo d&#237;a de su petici&#243;n&#46; En el 73&#37; de los estudios ecogr&#225;ficos bilaterales&#44; los hallazgos en una de las articulaciones ejemplificaban el resultado global emitido&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La ecograf&#237;a reumatol&#243;gica demuestra ser una t&#233;cnica &#250;til en la toma de decisiones&#44; cuyo mayor impacto se constata cuanto menor es el tiempo de espera hasta la evaluaci&#243;n de los resultados&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Objetivo"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "M&#233;todo"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusiones"
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      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objective</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">The purpose of the present study is to identify the extent to which rheumatological musculoskeletal ultrasound affects clinical decisions in a single-centre observational retrospective study&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Method</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">The results of 801 requests and 1174 consecutive individual ultrasound examinations performed over 10 months were analysed&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">The most frequent indication was diagnostic assistance &#40;39&#37;&#41; followed by assessment of inflammatory activity &#40;34&#37;&#41;&#46; By topography&#44; the hand was the most frequently studied region &#40;51&#37;&#41;&#44; followed by the foot &#40;18&#46;1&#37;&#41;&#46; Of all requests&#44; 67&#37; had an impact on decision-making&#46; The impact on clinical decision-making was associated with a shorter waiting time for the evaluation of the results&#44; being the greatest in those ultrasound scans performed on demand on the same day of the request&#46; In 73&#37; of bilateral ultrasound studies&#44; findings in one of the joints exemplified the overall result reported&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Rheumatological musculoskeletal ultrasound has proven to be a useful decision-making technique&#44; the greater the impact of which is seen the shorter the waiting time before it is performed&#46;</p></span>"
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            "identificador" => "abst0025"
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          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Results"
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          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusions"
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Frecuencia<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Tobillo y pie&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">17 &#40;15&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Rodilla&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1 &#40;2&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cadera&nbsp;\t\t\t\t\t\t\n
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          "es" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Distribuci&#243;n del impacto del resultado ecogr&#225;fico en la conducta del cl&#237;nico&#44; en funci&#243;n del tipo de ecograf&#237;a solicitada &#40;a demanda o programada&#41;</p>"
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                        "fecha" => "2014"
                        "volumen" => "10"
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23856277"
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Información del artículo
ISSN: 1699258X
Idioma original: Español
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