Rheumatology Department, Hospital Universitario de Gran Canaria Dr. Negrin, Las Palmas de Gran Canaria, Spain.
Clin Exp Rheumatol. 2012 Sep-Oct;30(5):768-71. Epub 2012 Oct 17.
To compare the routine use of musculoskeletal ultrasonography (MSUS) with traditional clinical care in daily practice at shoulder and hand level.
An observational study was performed in four rheumatology departments. Within each department, 2 rheumatologists were selected; one rheumatologist used MSUS, and the other followed traditional rheumatology care. Consecutive patients with nontraumatic pain, hand numbness or disability, or pain and/or limitations in the shoulder were selected. We collected information regarding the clinical and MSUS diagnoses, changes in diagnosis and treatment following MSUS, local injections, the rheumatologist's satisfaction and the use of health care resources. A descriptive analysis was performed.
A total of 168 patients were analysed, with 104 and 64 patients in the MSUS and traditional care groups, respectively. MSUS led to a diagnosis and therapeutic change in 53 (52%) and 55 patients (54%), respectively. The rate of local injection was 47% in the MSUS group (73% unexpected, 61% performed using US) compared with 21% in the traditional group (p=0.001). According to the rheumatologists, MSUS was useful in 72 cases (71%) and extremely useful in 20 cases (20%), and the rheumatologists reported a higher satisfaction with their patient evaluations (p<0.001). The MSUS group required fewer additional tests (38% vs. 81%, respectively, p<0.001), fewer medical visits (46% vs. 84%, p<0.001), and lower direct costs (11 vs. 30 euros, p<0.001) than the traditional care group.
Compared with traditional care, the routine use of MSUS in rheumatology practice at hand and shoulder level can lead to important improvements in care, thereby reducing the number of additional tests and medical visits.
比较肌肉骨骼超声（MSUS）在肩部和手部常规应用与传统临床护理的差异。
本研究为观察性研究，在四个风湿病科开展。每个科室选择 2 名风湿病医生，其中 1 名医生使用 MSUS，另 1 名医生采用传统风湿病护理方法。连续选择非创伤性肩部疼痛、手部麻木或无力、肩部疼痛和/或活动受限的患者。收集临床和 MSUS 诊断、MSUS 后诊断和治疗变化、局部注射、医生满意度以及卫生保健资源使用情况等信息。进行描述性分析。
共纳入 168 例患者，MSUS 组和传统护理组分别为 104 例和 64 例。MSUS 组和传统护理组分别有 53 例（52%）和 55 例（54%）患者的诊断和治疗发生变化。MSUS 组局部注射率为 47%（73%为意外发现，61%在超声引导下进行），传统护理组为 21%（p=0.001）。根据医生报告，MSUS 对 72 例（71%）患者有用，对 20 例（20%）患者极其有用，医生对患者评估的满意度更高（p<0.001）。MSUS 组需要进行的额外检查（38% vs. 81%，p<0.001）和就诊次数（46% vs. 84%，p<0.001）更少，直接费用（11 欧元 vs. 30 欧元，p<0.001）更低。
与传统护理相比，在手部和肩部风湿病常规护理中应用 MSUS 可显著改善护理质量，减少额外检查和就诊次数。
