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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introducci&#243;n</span><p id="par0005" class="elsevierStylePara elsevierViewall">Ante un dolor tor&#225;cico agudo &#40;DTA&#41; el m&#233;dico de urgencias debe discernir si su origen es banal o est&#225; causado por trastornos potencialmente mortales como el s&#237;ndrome coronario agudo &#40;SCA&#41;&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">El DTA es un s&#237;ntoma frecuente de consulta&#44; que representa entre el 5-15&#37; del total de asistencias urgentes atendidas<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">1&#44;2</span></a>&#46; En Espa&#241;a<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">1&#44;3&#44;4</span></a>&#44; entre el 26 y el 46&#37; de casos de DTA son inicialmente considerados un SCA&#44; pero dados de alta posteriormente sin confirmarse dicho diagn&#243;stico&#46; No obstante&#44; el 2-10&#37; de los pacientes enviados a domicilio con el diagn&#243;stico de DTA no coronario tienen un SCA&#44; con peor pron&#243;stico que el de los correctamente identificados e ingresados&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Los pilares de la evaluaci&#243;n del paciente con DTA son la historia cl&#237;nica&#44; la exploraci&#243;n f&#237;sica&#44; el electrocardiograma y los biomarcadores card&#237;acos&#46; Posteriormente&#44; diversos protocolos cl&#237;nicos&#44; algoritmos de decisi&#243;n y escalas de puntuaci&#243;n<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">5-10</span></a> han intentado mejorar la efectividad y eficiencia en el diagn&#243;stico del DTA&#44; pero no se han validado para discernir si el origen del DTA es o no coronario&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Cuando se inquiere a pacientes con DTA cuestiones como &#171;mu&#233;streme d&#243;nde tiene el dolor&#187; y &#171;&#191;c&#243;mo es&#63;&#187;&#44; muchos utilizan los movimientos de sus manos para localizar el dolor y transmitir su cualidad<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">11&#44;12</span></a>&#44; ilustrando gr&#225;ficamente sus s&#237;ntomas&#46; As&#237;&#44; importantes tratados de Cardiolog&#237;a<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">13-17</span></a> han hecho referencia al signo de Levine&#44; y otros&#44; como sugestivos o incluso patognom&#243;nicos del origen coronario del DTA&#46; Un pu&#241;o cerrado sobre el estern&#243;n &#40;signo de Levine<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">13</span></a>&#44; <a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>A&#41; transmite una cualidad desgarradora del dolor&#46; Una mano extendida describe la sensaci&#243;n de pesadez en el t&#243;rax &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>B&#41;&#46; Una sensaci&#243;n de banda constrictiva en el t&#243;rax puede ser representada por un movimiento lateral de la superficie palmar de ambas manos desde el centro del pecho &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>C&#41;&#46; Los pacientes con dolor de origen no coronario pueden utilizar otras posiciones o movimientos para ilustrar su dolor&#44; como el de los dedos arriba y abajo del estern&#243;n &#40;dolor esof&#225;gico&#41; o a punta de dedo &#40;dolor de pared tor&#225;cica<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">18</span></a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">En la literatura son escasos los estudios que analizan la validez de estos signos en el diagn&#243;stico del SCA&#44; y sus resultados poco concluyentes&#44; a pesar de haberse realizado en pacientes previamente seleccionados de unidades coronarias<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">11&#44;12</span></a>&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Por ello&#44; este estudio analiza la frecuencia y validez diagn&#243;stica de estos signos gestuales en una cohorte de pacientes que consultaron al servicio de urgencias hospitalario &#40;SUH&#41; por DTA&#46; La hip&#243;tesis inicial fue que el lenguaje gestual de las manos tiene validez diagn&#243;stica para identificar el DTA coronario y distinguirlo del no coronario&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Pacientes y m&#233;todos</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Dise&#241;o</span><p id="par0035" class="elsevierStylePara elsevierViewall">Estudio de cohortes prospectivo de una muestra de pacientes mayores de 14 a&#241;os atendidos en un SUH por DTA&#44; entre el 1 de junio de 2013 y el 31 de mayo de 2014&#46; Este SUH asiste aproximadamente 125&#46;000 urgencias&#47;a&#241;o&#46; La selecci&#243;n de pacientes se realiz&#243; mediante muestreo por lotes&#46; Cada lote incluy&#243; todos los pacientes que&#44; de forma consecutiva&#44; consultaron por DTA durante la jornada laboral de los investigadores participantes&#46; Se excluyeron los pacientes que se negaron a participar en el estudio&#44; aquellos cuyo nivel cognitivo&#44; dificultades en la comunicaci&#243;n o limitaci&#243;n funcional &#40;apraxias&#44; hemiparesias&#44; etc&#46;&#41; les imped&#237;a realizar el test&#44; y todos los DTA causados por traumatismos&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">El estudio fue aprobado por el Comit&#233; de Investigaci&#243;n local y se solicit&#243; el consentimiento informado de todos los participantes&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">A todos los pacientes se les realiz&#243; una anamnesis de aquellas variables incluidas en la hoja de recogida de datos &#40;HRD&#41;&#46; El resto de variables se obtuvieron a trav&#233;s de las distintas aplicaciones inform&#225;ticas del centro sanitario&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">B&#250;squeda bibliogr&#225;fica</span><p id="par0050" class="elsevierStylePara elsevierViewall">Se emplearon las palabras clave <span class="elsevierStyleItalic">chest pain</span> y <span class="elsevierStyleItalic">body language</span>&#44; sin limitaci&#243;n temporal&#46; Se utiliz&#243; el metabuscador GERION de la Biblioteca Virtual del Sistema Sanitario P&#250;blico de Andaluc&#237;a&#44; que utiliza las siguientes bases de datos de ciencias de la salud&#58; CINAHL&#44; EMBASE&#44; <span class="elsevierStyleItalic">Educational Resources Information Center</span> &#40;ERIC&#41;&#44; IME-Biomedicina&#44; MEDLINE&#44; PubMed&#44; y SciELO <span class="elsevierStyleItalic">&#40;Scientific Electronic Library Online&#41;</span>&#46; Tambi&#233;n se analizaron las citas bibliogr&#225;ficas incluidas en los trabajos encontrados en las bases de datos bibliom&#233;dicas referidas&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Variables del estudio</span><p id="par0055" class="elsevierStylePara elsevierViewall">La HRD conten&#237;a las variables&#58; edad&#44; sexo&#44; tiempo de evoluci&#243;n del dolor&#44; clasificaci&#243;n del riesgo coronario de la <span class="elsevierStyleItalic">American Heart Association</span> &#40;AHA&#41; seg&#250;n el electrocardiograma<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">19</span></a>&#44; juicio diagn&#243;stico emitido sobre el DTA en el SUH &#40;card&#237;aco&#44; no card&#237;aco o de origen incierto&#41;&#44; ingreso en el &#225;rea de observaci&#243;n &#40;no&#47;s&#237;&#41;&#44; destino del paciente &#40;domicilio&#44; planta de cardiolog&#237;a&#44; cuidados intensivos u otros&#41;&#44; tipo de gesto con las manos &#40;gesto 1&#44; o mano en pu&#241;o dispuesta sobre la zona esternal o signo de Levine&#59; gesto 2&#44; o mano abierta situada en la misma localizaci&#243;n&#59; gesto 3&#44; referido a ambas manos colocadas en el centro del t&#243;rax&#59; u otros signos&#41;&#44; resultado de la coronariograf&#237;a &#40;normal&#47;patol&#243;gica&#41;&#44; determinaci&#243;n s&#233;rica de troponina <span class="elsevierStyleSmallCaps">I</span> &#40;negativa&#47;positiva&#41;&#44; angiograf&#237;a coronaria por tomograf&#237;a computarizada &#40;angioTC&#41; &#40;normal&#47;patol&#243;gica&#41;&#44; grupo diagn&#243;stico final &#40;SCA&#47;no SCA&#41; y diagn&#243;stico etiol&#243;gico&#46; La variable &#171;grupo diagn&#243;stico final&#187; fue la variable dependiente&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Los signos gestuales considerados figuraban representados gr&#225;ficamente en la HRD y correspond&#237;an a los 3 m&#225;s descritos en la literatura<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">13&#44;14</span></a> &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>A-C&#41; como asociados al DTA coronario&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Sistem&#225;tica de recogida de datos</span><p id="par0065" class="elsevierStylePara elsevierViewall">Cinco facultativos del SUH realizaron la anamnesis y recogida de datos de los pacientes incluidos en el estudio&#46; Estos investigadores fueron inicialmente entrenados mediante series de concordancia sobre los mismos casos&#44; hasta obtener un &#237;ndice kappa de al menos el 80&#37;&#46; La entrevista se realiz&#243; durante el primer contacto con el paciente&#44; desconociendo en ese momento el evaluador el diagn&#243;stico preciso&#46; Se llev&#243; a cabo en el &#225;rea de consultas del SUH y&#44; ocasionalmente&#44; en el &#225;rea de observaci&#243;n&#46; Si exist&#237;a inestabilidad hemodin&#225;mica u otra situaci&#243;n que imposibilitara la anamnesis en el SUH&#44; se aplicaba el tratamiento oportuno y se realizaba posteriormente&#44; una vez estabilizado el paciente&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Se registr&#243; el tipo de signo expresado con las manos tras realizar el investigador una introducci&#243;n est&#225;ndar&#58; &#171;mu&#233;streme d&#243;nde tiene el dolor y d&#237;game como lo siente&#187;&#44; adjudicando el m&#233;dico el gesto observado a alguno de los dibujos reflejados en la HRD &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>A-C&#41;&#46; Cualquier otro signo distinto tambi&#233;n se registraba en la HRD&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Una coronariograf&#237;a se consider&#243; patol&#243;gica cuando se hall&#243; una lesi&#243;n obstructiva significativa &#40;&#62;<span class="elsevierStyleHsp" style=""></span>50&#37; de la luz&#41; en vasos epic&#225;rdicos mayores de 2<span class="elsevierStyleHsp" style=""></span>mm de di&#225;metro<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">20</span></a>&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Los datos de laboratorio se obtuvieron de la aplicaci&#243;n <span class="elsevierStyleItalic">nexus IT</span> V&#46;3&#46;8&#46;9&#46;0 &#40;DigitasLBi Company&#41;&#46; La troponina <span class="elsevierStyleSmallCaps">I</span> s&#233;rica se determin&#243; por quimioluminiscencia con el analizador Architect ci16200 de Abott<span class="elsevierStyleSup">&#174;</span>&#46; Se consider&#243; positivo un valor mayor de 0&#44;30<span class="elsevierStyleHsp" style=""></span>ng&#47;ml&#46; La angioTC de arterias coronarias se realiz&#243; con un medidor General Electric<span class="elsevierStyleSup">&#174;</span> de 64 cortes&#44; utilizando contraste con iopromida 370 &#40;Ultravist<span class="elsevierStyleSup">&#174;</span>&#41;&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Diagn&#243;stico y seguimiento de los pacientes</span><p id="par0085" class="elsevierStylePara elsevierViewall">Los pacientes fueron finalmente asignados a 2 grupos diagn&#243;sticos&#58; grupo SCA cuando se confirm&#243; el origen coronario&#59; y grupo no SCA cuando se evidenci&#243; otro origen o aquel no se pudo confirmar&#46; La confirmaci&#243;n del origen coronario y su categorizaci&#243;n &#40;&#225;ngor estable&#44; &#225;ngor inestable&#44; &#225;ngor hemodin&#225;mico&#44; infarto agudo de miocardio&#41; se realiz&#243; siguiendo los criterios vigentes relativos a la cl&#237;nica&#44; valor pico de troponina en las primeras 24<span class="elsevierStyleHsp" style=""></span>h&#44; electrocardiograma&#44; estudio de imagen &#40;angioTC&#41;&#44; y coronariograf&#237;a<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">21-26</span></a>&#46; Los pacientes catalogados de &#171;&#225;ngor hemodin&#225;mico&#187; se encuadraron en el grupo no SCA&#44; salvo evidencia de lesi&#243;n coronaria&#46; Los diversos tipos de DTA no coronario se diagnosticaron seg&#250;n criterios est&#225;ndar&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Para verificar el diagn&#243;stico final del episodio&#44; todos los casos se siguieron hasta el alta y durante los 12 meses siguientes&#44; revis&#225;ndose las visitas m&#233;dicas posteriores&#46; En los pacientes en que estas no se pudieron verificar&#44; se realiz&#243; una entrevista telef&#243;nica para corroborar la aparici&#243;n de eventos coronarios intercurrentes o el fallecimiento por esta causa&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">An&#225;lisis estad&#237;stico</span><p id="par0095" class="elsevierStylePara elsevierViewall">El c&#225;lculo del tama&#241;o muestral se realiz&#243; para la estimaci&#243;n de una proporci&#243;n en una poblaci&#243;n finita&#44; considerando que el 5&#37; de los pacientes atendidos en un SUH<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">2&#44;27</span></a> lo son por dolor tor&#225;cico &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>6&#46;250 casos de dolor tor&#225;cico en nuestro caso&#41;&#44; que la proporci&#243;n de cardiopat&#237;a isqu&#233;mica es del 10&#37;<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">2&#44;3&#44;28</span></a>&#44; y aceptando una imprecisi&#243;n m&#225;xima de &#177;<span class="elsevierStyleHsp" style=""></span>3&#37;&#44; con un nivel de confianza en la estimaci&#243;n del 95&#37;&#46; El tama&#241;o muestral m&#237;nimo calculado fue de 362 casos&#46; Los casos perdidos por cualquier causa se repusieron con el caso inmediatamente posterior&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Los datos recogidos se incluyeron en la aplicaci&#243;n inform&#225;tica SPSS 17&#46;0 &#40;SPSS Inc&#46; Released 2008&#46; SPSS Statistics for Windows&#44; Version 17&#46;0&#46; Chicago&#58; SPSS Inc&#46;&#41;&#46; El grado de concordancia interobservador de los entrevistadores sobre los mismos casos en la fase de entrenamiento previa se calcul&#243; mediante el &#237;ndice kappa&#44; determin&#225;ndose como acuerdo aceptable un &#237;ndice &#8805;<span class="elsevierStyleHsp" style=""></span>0&#44;80 &#40;80&#37;&#41;&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Se realiz&#243; un estudio univariante utilizando una distribuci&#243;n de frecuencias absolutas y relativas&#46; Las variables cuantitativas se expresaron con la media aritm&#233;tica o la mediana&#44; y su desviaci&#243;n est&#225;ndar &#40;DE&#41; o amplitud intercuartil &#40;AI&#41;&#44; respectivamente&#46; La distribuci&#243;n normal de los datos se determin&#243; por el test de Kolmogorov-Smirnov&#46; Para analizar la asociaci&#243;n de las variables cualitativas respecto a la variable dependiente &#171;dolor coronario&#58; s&#237;&#47;no&#187; se utiliz&#243; la prueba de la &#967;<span class="elsevierStyleSup">2</span>&#44; de significaci&#243;n bilateral&#44; con prueba exacta de Fisher en su caso&#44; consider&#225;ndose significativa una p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#46; La validez diagn&#243;stica se midi&#243; mediante el c&#225;lculo de la sensibilidad&#44; especificidad&#44; valor predictivo positivo &#40;VPP&#41;&#44; valor predictivo negativo &#40;VPN&#41;&#44; cocientes de probabilidad o <span class="elsevierStyleItalic">likelihood ratio</span> positivos &#40;CPP&#41; y negativos &#40;CPN&#41; y el valor diagn&#243;stico global<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">29</span></a>&#44; con sus respectivos intervalos de confianza del 95&#37; &#40;IC 95&#37;&#41;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">30</span></a>&#46;</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Resultados</span><p id="par0110" class="elsevierStylePara elsevierViewall">Se incluyeron 383 pacientes&#44; de los cuales 164 &#40;43&#37;&#41; correspondieron al grupo SCA y 219 &#40;57&#37;&#41; al de no SCA &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0115" class="elsevierStylePara elsevierViewall">El signo m&#225;s frecuentemente realizado fue el gesto 2&#44; globalmente &#40;60&#37;&#41; y por grupos diagn&#243;sticos &#40;60&#37; en el grupo SCA y 58&#37; en el grupo no SCA&#41;&#46; No hubo asociaci&#243;n estad&#237;sticamente significativa entre el tipo de gesto y el grupo diagn&#243;stico final &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;172&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46; El grupo no SCA&#44; en comparaci&#243;n con el SCA&#44; realiz&#243; con m&#225;s frecuencia gestos diferentes de los cl&#225;sicos 1&#44; 2 o 3 &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;030&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46; No hubo asociaci&#243;n entre el tipo de gesto y los diagn&#243;sticos espec&#237;ficos del grupo SCA &#40;&#225;ngor estable&#44; &#225;ngor inestable&#44; &#225;ngor hemodin&#225;mico e infarto agudo de miocardio&#41; &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;76&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0120" class="elsevierStylePara elsevierViewall">La validez diagn&#243;stica de los signos gestuales se expone en la <a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#46; Para el diagn&#243;stico de dolor coronario&#44; la mayor sensibilidad se obtuvo aisladamente por el gesto 2 &#40;60&#37;&#41;&#59; la mayor especificidad por el signo de Levine &#40;gesto 1&#41; &#40;90&#37;&#41;&#44; seguida de otros gestos &#40;86&#37;&#41; y del gesto 3 &#40;81&#37;&#41;&#46; No se registraron eventos coronarios o fallecimiento por causa coronaria de los pacientes durante el seguimiento&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Discusi&#243;n</span><p id="par0125" class="elsevierStylePara elsevierViewall">El presente estudio&#44; el tercero de este tipo reflejado en la literatura m&#233;dica revisada<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">11&#44;12</span></a> y el primero realizado en un SUH&#44; demuestra que la realizaci&#243;n por parte de los pacientes de determinados gestos con las manos no es &#250;til para determinar si el DTA es o no coronario&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Se considera que una prueba diagn&#243;stica tiene una validez aceptable si su sensibilidad y especificidad son iguales o superiores al 80&#37;<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">31</span></a>&#46; En nuestro estudio&#44; excepto el gesto 2&#44; los restantes signos considerados de manera aislada tuvieron una especificidad mayor del 80&#37;&#44; aunque una baja sensibilidad y valores predictivos&#44; e insuficiente precisi&#243;n diagn&#243;stica&#46; En t&#233;rminos de cocientes de probabilidad&#44; que son independientes de la prevalencia&#44; los resultados muestran valores de CPP ligeramente superiores a 1 para los gestos 1&#44; 2 y 3 &#40;1&#44;20 para el signo de Levine&#41;&#44; mientras que ninguno de los CPN fueron inferiores a 1&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Edmondstone<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">11</span></a> public&#243; en 1995 un breve art&#237;culo sobre la validez diagn&#243;stica del lenguaje de las manos en 203 pacientes con DTA de una unidad de cuidados coronarios&#46; El DTA fue coronario en 138 pacientes &#40;68&#37;&#41;&#44; y no coronario o indeterminado en 65 &#40;32&#37;&#41;&#44; con una elevada proporci&#243;n de pacientes coronarios respecto a nuestro estudio dada la procedencia de los mismos&#46; Su conclusi&#243;n fue que estos signos no son discriminativos para el diagn&#243;stico de dolor coronario&#46; No obstante&#44; bas&#225;ndose en una sensibilidad del 80&#37; y un VPP del 77&#37;&#44; concluyeron que la realizaci&#243;n de alguno de los 3 gestos podr&#237;a apoyar el diagn&#243;stico de SCA&#46; Estos resultados no son congruentes con nuestro estudio&#44; en donde el VPP fue solo del 45&#37; al considerar la realizaci&#243;n de cualquiera de los 3 signos frente a otros signos&#44; aunque la sensibilidad fue elevada &#40;93&#37;&#41;&#46; No obstante&#44; los CPP y CPN de nuestro estudio al considerar&#44; como hizo Edmondstone<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">11</span></a>&#44; la valoraci&#243;n conjunta de los gestos 1&#44; 2 o 3 &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41; demuestran la ausencia de validez diagn&#243;stica de estos signos&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">En el estudio de Marcus et al&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">12</span></a> sobre 202 pacientes ingresados en el hospital por DTA&#44; se explor&#243; el signo de Levine &#40;gesto 1&#41;&#44; el gesto 2 &#40;como en nuestro estudio&#41;&#44; y otros 2 signos distintos &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>D y E&#41;&#46; De los sujetos incluidos&#44; 107 &#40;53&#37;&#41; realizaron alguno de los 4 gestos&#58; el signo de Levine el 11&#37;&#44; el gesto 2 el 35&#37;&#44; el tercer gesto el 16&#37; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>D&#41; y el signo de la punta de dedo el 4&#37; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>E&#41;&#46; Tan solo la especificidad del signo de Levine &#40;84&#37;&#41; fue significativa&#44; similar a la de nuestro estudio &#40;89&#37;&#41;&#46; Al comparar los resultados alcanzados por estos 2 estudios previos y el actual &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a><span class="elsevierStyleBold">&#41;</span> se observa que&#44; aunque realizados en distintos &#225;mbitos&#44; no son demasiado dispares&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0145" class="elsevierStylePara elsevierViewall">Nuestro estudio no pretende simplificar el acto diagn&#243;stico a una simple expresi&#243;n corporal&#46; El diagn&#243;stico m&#233;dico requiere la integraci&#243;n de informaci&#243;n variada&#44; en ocasiones no bien establecida&#44; que incluye gestos&#44; posturas&#44; modos de expresi&#243;n verbal&#44; informaci&#243;n de los acompa&#241;antes&#44; entre otros muchos&#44; bas&#225;ndose en reglas y conclusiones heur&#237;sticas dif&#237;ciles de identificar&#46; Por ello&#44; raramente un diagn&#243;stico m&#233;dico &#40;o hip&#243;tesis diagn&#243;stica&#41; se basa en un &#250;nico aspecto de la historia cl&#237;nica o de la exploraci&#243;n f&#237;sica&#59; m&#225;s bien requiere integrar una informaci&#243;n compleja y variada para llegar a una conclusi&#243;n&#46; As&#237;&#44; no sorprende que en el presente estudio la expresividad del paciente&#44; considerada de forma aislada&#44; no aporte informaci&#243;n suficiente para alcanzar una conclusi&#243;n diagn&#243;stica segura&#46; &#218;nicamente se ha pretendido cuantificar la precisi&#243;n diagn&#243;stica de unos gestos que&#44; en alg&#250;n caso como el signo de Levine&#44; han sido considerados de utilidad en tratados cl&#225;sicos<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">13&#44;14&#44;15&#44;16&#44;17</span></a> y a&#250;n se siguen afirmando en algunos casos como de indiscutible valor semiol&#243;gico<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">32</span></a>&#44; incluso patognom&#243;nico&#44; de enfermedad coronaria&#46; Tampoco puede inferirse de este estudio que la manera en que se expresa el paciente no tenga inter&#233;s alguno&#46; Es un eslab&#243;n m&#225;s de una cadena que conduce finalmente a una conclusi&#243;n o hip&#243;tesis diagn&#243;stica&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Entre las limitaciones del estudio figuran el tipo de muestreo realizado&#44; por conglomerados&#59; que cada paciente fue entrevistado por solo un evaluador &#40;aunque el an&#225;lisis de concordancia previo minimiza esta limitaci&#243;n&#41;&#44; y que no todos los pacientes recibieron las mismas exploraciones para llegar al diagn&#243;stico final &#40;se realiz&#243; coronariograf&#237;a al 40&#37; de pacientes y angioTC coronario al 25&#37; del total de la muestra&#41;&#46; Adem&#225;s&#44; es posible que los pacientes diab&#233;ticos&#44; por su posible disautonom&#237;a&#44; pudiesen tener variaciones en la intensidad o localizaci&#243;n del dolor&#44; lo que implicar&#237;a un posible sesgo de selecci&#243;n&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Como conclusi&#243;n&#44; algunos signos que los pacientes con DTA realizan con las manos tienen una alta frecuencia &#40;89&#37;&#41;&#44; aunque no son &#250;tiles para determinar un posible origen coronario&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Conflicto de intereses</span><p id="par0160" 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">Objetivos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Comprobar la frecuencia de 3 gestos realizados con las manos por los pacientes con dolor tor&#225;cico y determinar su validez diagn&#243;stica en el s&#237;ndrome coronario agudo&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Pacientes y m&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Estudio prospectivo de 383 pacientes adultos asistidos en un servicio de urgencias por dolor tor&#225;cico&#46; Se observ&#243; la realizaci&#243;n de determinados signos gestuales con las manos&#44; previamente referidos en la literatura m&#233;dica como caracter&#237;sticos de dolor coronario &#40;gesto 1&#58; mano en pu&#241;o dispuesta sobre zona esternal o signo de Levine&#59; gesto 2&#58; mano abierta situada en la misma localizaci&#243;n&#59; gesto 3&#58; ambas manos colocadas en el centro del t&#243;rax&#41;&#44; as&#237; como la de otros gestos&#46; Se analiz&#243; su asociaci&#243;n con el origen coronario del dolor&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">En 164 &#40;43&#37;&#41; pacientes se confirm&#243; el origen coronario del dolor &#40;grupo SCA&#41;&#44; y en 219 &#40;57&#37;&#41; no se confirm&#243; &#40;grupo no SCA&#41;&#46; Un 89&#37; de pacientes identificaron su dolor con alguno de los 3 gestos cl&#225;sicos&#46; El m&#225;s frecuente fue el 2&#44; tanto globalmente &#40;59&#37;&#41; como por grupos &#40;60&#37; grupo SCA&#59; 57&#44;5&#37; grupo no SCA&#41;&#46; No hubo asociaci&#243;n significativa entre el tipo de gesto realizado y el diagn&#243;stico final &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;172&#41;&#46; La mayor especificidad correspondi&#243; al signo de Levine &#40;90&#37;&#41;&#44; seguida de otros gestos &#40;86&#37;&#41; y del gesto 3 &#40;81&#37;&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Aunque el 89&#37; de los pacientes expresaron el dolor tor&#225;cico con alguno de los 3 gestos manuales cl&#225;sicamente asociados al dolor coronario&#44; ninguno de ellos alcanz&#243; suficiente precisi&#243;n diagn&#243;stica para ser utilizado como indicativo de este tipo de dolor&#46;</p></span>"
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            "titulo" => "Pacientes y m&#233;todos"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objectives</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">To determine the frequency of 3 hand gestures by patients with chest pain and determine the diagnostic validity of the gestures in acute coronary syndrome&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Patients and methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">A prospective study was conducted on 383 adult patients treated for chest pain in an emergency department&#46; We observed certain hand gestures&#44; previously referred to in the medical literature as characteristic of coronary pain &#40;gesture 1&#58; a clenched fist held over the sternal area or Levine&#39;s sign&#59; gesture 2&#58; open hand located over the same area&#59; gesture 3&#58; both hands placed in the centre of the chest&#41;&#44; as well as other gestures&#46; We analysed their association with the coronary origin of the pain&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">We confirmed the coronary origin of the pain in 164 &#40;43&#37;&#41; patients &#40;ACS group&#41;&#46; The other 219 patients &#40;57&#37;&#41; did not have a coronary origin for the pain &#40;nonACS group&#41;&#46; Eighty-nine percent of the patients identified their pain with one of the 3 classical gestures&#46; The most frequent gesture was number 2&#44; both overall &#40;59&#37;&#41; and by group &#40;60&#37; ACS group&#59; 57&#46;5&#37; nonACS group&#41;&#46; There was no significant association between the type of gesture and the final diagnosis &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;172&#41;&#46; The greater specificity corresponded to Levine&#39;s sign &#40;90&#37;&#41;&#44; followed by other gestures &#40;86&#37;&#41; and gesture 3 &#40;81&#37;&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Although 89&#37; of the patients expressed their chest pain with one of the 3 manual gestures classically associated with coronary pain&#44; none achieved sufficient diagnostic accuracy to be used as indicative of this type of pain&#46;</p></span>"
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          "es" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">A&#41; Signo de Levine&#58; mano en pu&#241;o en el centro del t&#243;rax&#46; B&#41; Mano extendida en el centro del t&#243;rax&#46; C&#41; Ambas manos colocadas en el centro del t&#243;rax desplaz&#225;ndolas hacia fuera &#40;explorados por Edmondstone<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">11</span></a> en 1995&#41;&#46; D y E&#41; Otros signos de las manos explorados por Marcus et al&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">12</span></a>&#46;</p>"
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          "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">AHA&#58; <span class="elsevierStyleItalic">American Heart Association</span>&#59; AI&#58; amplitud intercuartil&#59; BCRI&#58; bloqueo completo de rama izquierda&#59; ECG&#58; electrocardiograma&#59; ORL&#58; origen otorrinolaringol&#243;gico&#59; SCA&#58; s&#237;ndrome coronario agudo&#59; ST&#58; segmento ST&#59; UCI&#58; unidad de cuidados intensivos&#46;</p>"
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                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Edad &#40;AI&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">66 &#40;23&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Sexo</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Var&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">211&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">55&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Mujer&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Tiempo de evoluci&#243;n del dolor en horas &#40;AI&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Clasificaci&#243;n de riesgo coronario de la AHA seg&#250;n hallazgos ECG</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Con elevaci&#243;n ST o nuevo BCRI&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Con descenso ST o inversi&#243;n din&#225;mica de la onda T&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>ECG no diagn&#243;stico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">329&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">86&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Juicio diagn&#243;stico sobre el dolor reflejado en urgencias</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Card&#237;aco&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">181&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">47&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No card&#237;aco&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">134&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">82&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Origen incierto&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">68&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Ingreso en observaci&#243;n</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">191&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">192&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Destino del paciente</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Domicilio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">228&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Planta de cardiolog&#237;a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">117&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>UCI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Otros&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Diagn&#243;stico final dolor de origen coronario &#40;grupo SCA&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#193;ngor estable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#193;ngor inestable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">85&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Infarto agudo de miocardio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">39&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#193;ngor hemodin&#225;mico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Total grupo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">164&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Dolor de origen no coronario &#40;grupo no SCA&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Peric&#225;rdico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Pulmonar&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Digestivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Musculoesquel&#233;tico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Psic&#243;geno&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>ORL &#40;faringolar&#237;ngeo&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Indeterminado&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">119&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Total grupo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">219&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "es" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Caracter&#237;sticas generales de la cohorte</p>"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " rowspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Modalidad de realizaci&#243;n gestual</th><th class="td" title="table-head  " rowspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Gesto realizado por el paciente</th><th class="td" title="table-head  " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Dolor coronario</th><th class="td" title="table-head  " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Dolor no coronario</th><th class="td" title="table-head  " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Total</th><th class="td" title="table-head  " rowspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Valor de p</th></tr><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">&#8595; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">&#8594;&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">&#8595; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">&#8594; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">&#8595; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">&#8594;&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " rowspan="5" align="center" valign="middle">Tipo de gesto</td><td class="td" title="table-entry  " align="left" valign="top">Gesto 1 &#40;Levine&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">47&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">52&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="5" align="center" valign="middle">0&#44;172</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Gesto 2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">99&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">60&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">44&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">126&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">57&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">56&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">225&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">58&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Gesto 3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">45&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">41&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">18&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">54&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">75&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">19&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Otros gestos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">73&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">41&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">164&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">42&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">219&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">57&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">383&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="3" align="center" valign="middle">Gestos 1&#44; 2 o 3 vs&#46; otros gestos</td><td class="td" title="table-entry  " align="left" valign="top">Gesto 1&#44; 2 o 3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">153&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">93&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">44&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">189&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">86&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">55&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">342&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">89&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="3" align="center" valign="middle">0&#44;030</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Otros gestos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">73&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">41&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">164&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">42&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">219&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">57&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">383&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1427029.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "es" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Distribuci&#243;n de casos seg&#250;n el gesto realizado</p>"
        ]
      ]
      3 => array:8 [
        "identificador" => "tbl0015"
        "etiqueta" => "Tabla 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at3"
            "detalle" => "Tabla "
            "rol" => "short"
          ]
        ]
        "tabla" => array:3 [
          "leyenda" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">IC 95&#37;&#58; intervalos de confianza del 95&#37;&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " rowspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Validez diagn&#243;stica</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Gesto 1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Gesto 2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Gesto 3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Otros gestos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Gestos 1&#44; 2 o 3 vs&#46; otros gestos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Valor &#40;IC 95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Valor &#40;IC 95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Valor &#40;IC 95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Valor &#40;IC 95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Valor &#40;IC 95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Sensibilidad&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&#44;2 &#40;8-18&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">60&#44;4 &#40;52&#44;7-67&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&#44;7 &#40;15&#44;2-27&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#44;7 &#40;3&#44;8-11&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">93&#44;3 &#40;88&#44;4-96&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Especificidad&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">90 &#40;85-93&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">42&#44;5 &#40;36&#44;1-49&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">81&#44;3 &#40;75&#44;6-85&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">86&#44;3 &#40;81&#44;1-90&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&#44;7 &#40;9&#44;8-18&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Valor predictivo positivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">45&#44;5 &#40;32-60&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">44 &#40;37&#44;7-50&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">45&#44;3 &#40;34&#44;6-56&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26&#44;8 &#40;15&#44;7-41&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">44&#44;7 &#40;39&#44;6-50&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Valor predictivo negativo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">58 &#40;52&#44;5-63&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">58&#44;9 &#40;51&#44;0-66&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">57&#44;8 &#40;52&#44;2-63&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">55&#44;3 &#40;50-60&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">73&#44;2 &#40;58&#44;1-84&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cociente de probabilidad positivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;2 &#40;0&#44;7-2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;1 &#40;0&#44;90-1&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;1 &#40;0&#44;8-1&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;5 &#40;0&#44;3-0&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;1 &#40;1-1&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cociente de probabilidad negativo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;98 &#40;0&#44;9-1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;93 &#40;0&#44;7-1&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;98 &#40;0&#44;9-1&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;1 &#40;1-1&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;5 &#40;0&#44;3-0&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Valor diagn&#243;stico global&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">57 &#40;52-61&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50&#44;1 &#40;45&#44;2-55&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">55&#44;3 &#40;50&#44;4-60&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">52&#44;2 &#40;47&#44;2-57&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">47&#44;8 &#40;42&#44;8-52&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "notaPie" => array:1 [
            0 => array:3 [
              "identificador" => "tblfn0005"
              "etiqueta" => "&#42;"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Datos extra&#237;dos de la <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "es" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Validez de cada uno de los signos de las manos en el diagn&#243;stico del dolor tor&#225;cico coronario<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">&#42;</span></a></p>"
        ]
      ]
      4 => array:8 [
        "identificador" => "tbl0020"
        "etiqueta" => "Tabla 4"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at4"
            "detalle" => "Tabla "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">&#8211;&#58; ausencia de datos o imposibilidad de extraerlos del art&#237;culo&#59; VPN&#58; valor predictivo negativo&#59; VPP&#58; valor predictivo positivo&#46;</p><p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">Se prescinde de cifras decimales porque el estudio de Marcus et al&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">12</span></a> no las proporciona&#46; Se ha aproximado el decimal a la unidad m&#225;s cercana&#46; No se dispone de las <span class="elsevierStyleItalic">likelihood ratio</span> o cocientes de probabilidad de los estudios a comparar&#46;</p><p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">Los datos entre par&#233;ntesis corresponden a los intervalos de confianza al 95&#37;&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " rowspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Signo</th><th class="td" title="table-head  " rowspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Test</th><th class="td" title="table-head  " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Estudios realizados<br>Autor&#44; n&#250;mero de pacientes y &#225;mbito</th></tr><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Edmondstone<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">11</span></a>&#44; 203 pacientes de unidad coronaria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Marcus et al&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">12</span></a>&#44; 202 pacientes de cardiolog&#237;a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Estudio actual&#44; 383 pacientes del servicio de urgencias&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " rowspan="5" align="left" valign="top">Gesto 1 &#40;Signo de Levine&#41; <elsevierMultimedia ident="201705300032536171"></elsevierMultimedia></td><td class="td" title="table-entry  " align="left" valign="top">Prevalencia&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Sensibilidad&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14 &#40;9-20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9 &#40;5-17&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12 &#40;8-18&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Especificidad&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">89 &#40;79-55&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">84 &#40;72-92&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">90 &#40;85-93&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">VPP&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">73 &#40;54-86&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50 &#40;27-73&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">45 &#40;32-60&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">VPN&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">32 &#40;26-40&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">31 &#40;28-44&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">58 &#40;52-63&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="5" align="left" valign="top">Gesto 2 <elsevierMultimedia ident="201705300032536172"></elsevierMultimedia></td><td class="td" title="table-entry  " align="left" valign="top">Prevalencia&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">59&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Sensibilidad&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">46 &#40;38-55&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">38 &#40;28-48&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">60 &#40;53-68&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Especificidad&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">74 &#40;62-83&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">67 &#40;54-78&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">42 &#40;36-49&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">VPP&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">79 &#40;69-86&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">65 &#40;52-77&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">44 &#40;38-51&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">VPN&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">39 &#40;31-48&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">39 &#40;30-49&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">59 &#40;51-66&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="5" align="left" valign="top">Gesto 3 <elsevierMultimedia ident="201705300032536173"></elsevierMultimedia></td><td class="td" title="table-entry  " align="left" valign="top">Prevalencia&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Sensibilidad&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20 &#40;14-27&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21 &#40;15-28&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Especificidad&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">86 &#40;76-92&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">81 &#40;76-86&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">VPP&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">75 &#40;59-86&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">45 &#40;35-57&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">VPN&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">33 &#40;27-41&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">58 &#40;52-63&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="6" align="left" valign="top">Otros gestos</td><td class="td" title="table-entry  " align="left" valign="top">Prevalencia&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Sensibilidad&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21 &#40;14-28&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7 &#40;4-12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Especificidad&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">51 &#40;39-63&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">86 &#40;81-90&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">VPP&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">47 &#40;35-59&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27 &#40;16-42&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">VPN&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">23 &#40;17-31&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">55 &#40;50-60&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">VPN&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">53 &#40;41-65&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">73 &#40;58-84&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                    0 => array:2 [
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                        0 => array:2 [
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                          "autores" => array:6 [
                            0 => "M&#46; Mart&#237;nez-Sell&#233;s"
                            1 => "H&#46; Bueno"
                            2 => "A&#46; Sacrist&#225;n"
                            3 => "A&#46; Est&#233;vez"
                            4 => "J&#46; Ortiz"
                            5 => "L&#46; Gallego"
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                        "paginaFinal" => "959"
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                      "titulo" => "La cardiopat&#237;a isqu&#233;mica en los servicios de urgencia hospitalarios&#46; Proyecto EVICURE"
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                        0 => array:2 [
                          "etal" => false
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                            0 => "L&#46; Garc&#237;a-Castrillo"
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                            2 => "E&#46; Recuerda Mart&#237;nez"
                            3 => "P&#46; Mu&#241;oz Cacho"
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                    0 => array:1 [
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                        "tituloSerie" => "Emergencias&#46;"
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                        "paginaFinal" => "190"
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                      "titulo" => "Caracter&#237;sticas y manejo de los pacientes con dolor tor&#225;cico no traum&#225;tico en los servicios de urgencias hospitalarios&#46; Resultados del estudio EVICURE II"
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                            2 => "A&#46; Loma-Osorio"
                            3 => "T&#46; Garc&#237;a-Camarero"
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                      "titulo" => "Manejo del s&#237;ndrome coronario agudo sin elevaci&#243;n del segmento ST en Espa&#241;a&#46; Estudio DESCARTES &#40;Descripci&#243;n del Estado de los S&#237;ndromes Coronarios Agudos en un Registro Temporal Espa&#241;ol&#41;"
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                            1 => "A&#46; Bardaj&#237;"
                            2 => "A&#46; Fern&#225;ndez-Ortiz"
                            3 => "J&#46; Marrugat"
                            4 => "H&#46; Mart&#237;"
                            5 => "M&#46; Heras"
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Original
Validez diagnóstica del lenguaje de las manos en el dolor torácico de origen coronario
Diagnostic validity of hand gestures in chest pain of coronary origin
F.J. Montero-Péreza,
Autor para correspondencia
javiermonteroperez@gmail.com

Autor para correspondencia.
, F. de Borja Quero-Espinosaa, M.J. Clemente-Millána, J.A. Castro-Giméneza, J. de Burgos-Marína, M.Á. Romero-Morenob
a Unidad de Gestión Clínica de Urgencias, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Hospital Universitario Reina Sofía, Universidad de Córdoba, Córdoba, España
b Unidad de Gestión Clínica de Cardiología, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Hospital Universitario Reina Sofía, Universidad de Córdoba, Córdoba, España
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          "es" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">A&#41; Signo de Levine&#58; mano en pu&#241;o en el centro del t&#243;rax&#46; B&#41; Mano extendida en el centro del t&#243;rax&#46; C&#41; Ambas manos colocadas en el centro del t&#243;rax desplaz&#225;ndolas hacia fuera &#40;explorados por Edmondstone<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">11</span></a> en 1995&#41;&#46; D y E&#41; Otros signos de las manos explorados por Marcus et al&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">12</span></a>&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introducci&#243;n</span><p id="par0005" class="elsevierStylePara elsevierViewall">Ante un dolor tor&#225;cico agudo &#40;DTA&#41; el m&#233;dico de urgencias debe discernir si su origen es banal o est&#225; causado por trastornos potencialmente mortales como el s&#237;ndrome coronario agudo &#40;SCA&#41;&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">El DTA es un s&#237;ntoma frecuente de consulta&#44; que representa entre el 5-15&#37; del total de asistencias urgentes atendidas<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">1&#44;2</span></a>&#46; En Espa&#241;a<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">1&#44;3&#44;4</span></a>&#44; entre el 26 y el 46&#37; de casos de DTA son inicialmente considerados un SCA&#44; pero dados de alta posteriormente sin confirmarse dicho diagn&#243;stico&#46; No obstante&#44; el 2-10&#37; de los pacientes enviados a domicilio con el diagn&#243;stico de DTA no coronario tienen un SCA&#44; con peor pron&#243;stico que el de los correctamente identificados e ingresados&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Los pilares de la evaluaci&#243;n del paciente con DTA son la historia cl&#237;nica&#44; la exploraci&#243;n f&#237;sica&#44; el electrocardiograma y los biomarcadores card&#237;acos&#46; Posteriormente&#44; diversos protocolos cl&#237;nicos&#44; algoritmos de decisi&#243;n y escalas de puntuaci&#243;n<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">5-10</span></a> han intentado mejorar la efectividad y eficiencia en el diagn&#243;stico del DTA&#44; pero no se han validado para discernir si el origen del DTA es o no coronario&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Cuando se inquiere a pacientes con DTA cuestiones como &#171;mu&#233;streme d&#243;nde tiene el dolor&#187; y &#171;&#191;c&#243;mo es&#63;&#187;&#44; muchos utilizan los movimientos de sus manos para localizar el dolor y transmitir su cualidad<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">11&#44;12</span></a>&#44; ilustrando gr&#225;ficamente sus s&#237;ntomas&#46; As&#237;&#44; importantes tratados de Cardiolog&#237;a<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">13-17</span></a> han hecho referencia al signo de Levine&#44; y otros&#44; como sugestivos o incluso patognom&#243;nicos del origen coronario del DTA&#46; Un pu&#241;o cerrado sobre el estern&#243;n &#40;signo de Levine<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">13</span></a>&#44; <a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>A&#41; transmite una cualidad desgarradora del dolor&#46; Una mano extendida describe la sensaci&#243;n de pesadez en el t&#243;rax &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>B&#41;&#46; Una sensaci&#243;n de banda constrictiva en el t&#243;rax puede ser representada por un movimiento lateral de la superficie palmar de ambas manos desde el centro del pecho &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>C&#41;&#46; Los pacientes con dolor de origen no coronario pueden utilizar otras posiciones o movimientos para ilustrar su dolor&#44; como el de los dedos arriba y abajo del estern&#243;n &#40;dolor esof&#225;gico&#41; o a punta de dedo &#40;dolor de pared tor&#225;cica<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">18</span></a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">En la literatura son escasos los estudios que analizan la validez de estos signos en el diagn&#243;stico del SCA&#44; y sus resultados poco concluyentes&#44; a pesar de haberse realizado en pacientes previamente seleccionados de unidades coronarias<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">11&#44;12</span></a>&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Por ello&#44; este estudio analiza la frecuencia y validez diagn&#243;stica de estos signos gestuales en una cohorte de pacientes que consultaron al servicio de urgencias hospitalario &#40;SUH&#41; por DTA&#46; La hip&#243;tesis inicial fue que el lenguaje gestual de las manos tiene validez diagn&#243;stica para identificar el DTA coronario y distinguirlo del no coronario&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Pacientes y m&#233;todos</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Dise&#241;o</span><p id="par0035" class="elsevierStylePara elsevierViewall">Estudio de cohortes prospectivo de una muestra de pacientes mayores de 14 a&#241;os atendidos en un SUH por DTA&#44; entre el 1 de junio de 2013 y el 31 de mayo de 2014&#46; Este SUH asiste aproximadamente 125&#46;000 urgencias&#47;a&#241;o&#46; La selecci&#243;n de pacientes se realiz&#243; mediante muestreo por lotes&#46; Cada lote incluy&#243; todos los pacientes que&#44; de forma consecutiva&#44; consultaron por DTA durante la jornada laboral de los investigadores participantes&#46; Se excluyeron los pacientes que se negaron a participar en el estudio&#44; aquellos cuyo nivel cognitivo&#44; dificultades en la comunicaci&#243;n o limitaci&#243;n funcional &#40;apraxias&#44; hemiparesias&#44; etc&#46;&#41; les imped&#237;a realizar el test&#44; y todos los DTA causados por traumatismos&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">El estudio fue aprobado por el Comit&#233; de Investigaci&#243;n local y se solicit&#243; el consentimiento informado de todos los participantes&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">A todos los pacientes se les realiz&#243; una anamnesis de aquellas variables incluidas en la hoja de recogida de datos &#40;HRD&#41;&#46; El resto de variables se obtuvieron a trav&#233;s de las distintas aplicaciones inform&#225;ticas del centro sanitario&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">B&#250;squeda bibliogr&#225;fica</span><p id="par0050" class="elsevierStylePara elsevierViewall">Se emplearon las palabras clave <span class="elsevierStyleItalic">chest pain</span> y <span class="elsevierStyleItalic">body language</span>&#44; sin limitaci&#243;n temporal&#46; Se utiliz&#243; el metabuscador GERION de la Biblioteca Virtual del Sistema Sanitario P&#250;blico de Andaluc&#237;a&#44; que utiliza las siguientes bases de datos de ciencias de la salud&#58; CINAHL&#44; EMBASE&#44; <span class="elsevierStyleItalic">Educational Resources Information Center</span> &#40;ERIC&#41;&#44; IME-Biomedicina&#44; MEDLINE&#44; PubMed&#44; y SciELO <span class="elsevierStyleItalic">&#40;Scientific Electronic Library Online&#41;</span>&#46; Tambi&#233;n se analizaron las citas bibliogr&#225;ficas incluidas en los trabajos encontrados en las bases de datos bibliom&#233;dicas referidas&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Variables del estudio</span><p id="par0055" class="elsevierStylePara elsevierViewall">La HRD conten&#237;a las variables&#58; edad&#44; sexo&#44; tiempo de evoluci&#243;n del dolor&#44; clasificaci&#243;n del riesgo coronario de la <span class="elsevierStyleItalic">American Heart Association</span> &#40;AHA&#41; seg&#250;n el electrocardiograma<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">19</span></a>&#44; juicio diagn&#243;stico emitido sobre el DTA en el SUH &#40;card&#237;aco&#44; no card&#237;aco o de origen incierto&#41;&#44; ingreso en el &#225;rea de observaci&#243;n &#40;no&#47;s&#237;&#41;&#44; destino del paciente &#40;domicilio&#44; planta de cardiolog&#237;a&#44; cuidados intensivos u otros&#41;&#44; tipo de gesto con las manos &#40;gesto 1&#44; o mano en pu&#241;o dispuesta sobre la zona esternal o signo de Levine&#59; gesto 2&#44; o mano abierta situada en la misma localizaci&#243;n&#59; gesto 3&#44; referido a ambas manos colocadas en el centro del t&#243;rax&#59; u otros signos&#41;&#44; resultado de la coronariograf&#237;a &#40;normal&#47;patol&#243;gica&#41;&#44; determinaci&#243;n s&#233;rica de troponina <span class="elsevierStyleSmallCaps">I</span> &#40;negativa&#47;positiva&#41;&#44; angiograf&#237;a coronaria por tomograf&#237;a computarizada &#40;angioTC&#41; &#40;normal&#47;patol&#243;gica&#41;&#44; grupo diagn&#243;stico final &#40;SCA&#47;no SCA&#41; y diagn&#243;stico etiol&#243;gico&#46; La variable &#171;grupo diagn&#243;stico final&#187; fue la variable dependiente&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Los signos gestuales considerados figuraban representados gr&#225;ficamente en la HRD y correspond&#237;an a los 3 m&#225;s descritos en la literatura<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">13&#44;14</span></a> &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>A-C&#41; como asociados al DTA coronario&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Sistem&#225;tica de recogida de datos</span><p id="par0065" class="elsevierStylePara elsevierViewall">Cinco facultativos del SUH realizaron la anamnesis y recogida de datos de los pacientes incluidos en el estudio&#46; Estos investigadores fueron inicialmente entrenados mediante series de concordancia sobre los mismos casos&#44; hasta obtener un &#237;ndice kappa de al menos el 80&#37;&#46; La entrevista se realiz&#243; durante el primer contacto con el paciente&#44; desconociendo en ese momento el evaluador el diagn&#243;stico preciso&#46; Se llev&#243; a cabo en el &#225;rea de consultas del SUH y&#44; ocasionalmente&#44; en el &#225;rea de observaci&#243;n&#46; Si exist&#237;a inestabilidad hemodin&#225;mica u otra situaci&#243;n que imposibilitara la anamnesis en el SUH&#44; se aplicaba el tratamiento oportuno y se realizaba posteriormente&#44; una vez estabilizado el paciente&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Se registr&#243; el tipo de signo expresado con las manos tras realizar el investigador una introducci&#243;n est&#225;ndar&#58; &#171;mu&#233;streme d&#243;nde tiene el dolor y d&#237;game como lo siente&#187;&#44; adjudicando el m&#233;dico el gesto observado a alguno de los dibujos reflejados en la HRD &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>A-C&#41;&#46; Cualquier otro signo distinto tambi&#233;n se registraba en la HRD&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Una coronariograf&#237;a se consider&#243; patol&#243;gica cuando se hall&#243; una lesi&#243;n obstructiva significativa &#40;&#62;<span class="elsevierStyleHsp" style=""></span>50&#37; de la luz&#41; en vasos epic&#225;rdicos mayores de 2<span class="elsevierStyleHsp" style=""></span>mm de di&#225;metro<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">20</span></a>&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Los datos de laboratorio se obtuvieron de la aplicaci&#243;n <span class="elsevierStyleItalic">nexus IT</span> V&#46;3&#46;8&#46;9&#46;0 &#40;DigitasLBi Company&#41;&#46; La troponina <span class="elsevierStyleSmallCaps">I</span> s&#233;rica se determin&#243; por quimioluminiscencia con el analizador Architect ci16200 de Abott<span class="elsevierStyleSup">&#174;</span>&#46; Se consider&#243; positivo un valor mayor de 0&#44;30<span class="elsevierStyleHsp" style=""></span>ng&#47;ml&#46; La angioTC de arterias coronarias se realiz&#243; con un medidor General Electric<span class="elsevierStyleSup">&#174;</span> de 64 cortes&#44; utilizando contraste con iopromida 370 &#40;Ultravist<span class="elsevierStyleSup">&#174;</span>&#41;&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Diagn&#243;stico y seguimiento de los pacientes</span><p id="par0085" class="elsevierStylePara elsevierViewall">Los pacientes fueron finalmente asignados a 2 grupos diagn&#243;sticos&#58; grupo SCA cuando se confirm&#243; el origen coronario&#59; y grupo no SCA cuando se evidenci&#243; otro origen o aquel no se pudo confirmar&#46; La confirmaci&#243;n del origen coronario y su categorizaci&#243;n &#40;&#225;ngor estable&#44; &#225;ngor inestable&#44; &#225;ngor hemodin&#225;mico&#44; infarto agudo de miocardio&#41; se realiz&#243; siguiendo los criterios vigentes relativos a la cl&#237;nica&#44; valor pico de troponina en las primeras 24<span class="elsevierStyleHsp" style=""></span>h&#44; electrocardiograma&#44; estudio de imagen &#40;angioTC&#41;&#44; y coronariograf&#237;a<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">21-26</span></a>&#46; Los pacientes catalogados de &#171;&#225;ngor hemodin&#225;mico&#187; se encuadraron en el grupo no SCA&#44; salvo evidencia de lesi&#243;n coronaria&#46; Los diversos tipos de DTA no coronario se diagnosticaron seg&#250;n criterios est&#225;ndar&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Para verificar el diagn&#243;stico final del episodio&#44; todos los casos se siguieron hasta el alta y durante los 12 meses siguientes&#44; revis&#225;ndose las visitas m&#233;dicas posteriores&#46; En los pacientes en que estas no se pudieron verificar&#44; se realiz&#243; una entrevista telef&#243;nica para corroborar la aparici&#243;n de eventos coronarios intercurrentes o el fallecimiento por esta causa&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">An&#225;lisis estad&#237;stico</span><p id="par0095" class="elsevierStylePara elsevierViewall">El c&#225;lculo del tama&#241;o muestral se realiz&#243; para la estimaci&#243;n de una proporci&#243;n en una poblaci&#243;n finita&#44; considerando que el 5&#37; de los pacientes atendidos en un SUH<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">2&#44;27</span></a> lo son por dolor tor&#225;cico &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>6&#46;250 casos de dolor tor&#225;cico en nuestro caso&#41;&#44; que la proporci&#243;n de cardiopat&#237;a isqu&#233;mica es del 10&#37;<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">2&#44;3&#44;28</span></a>&#44; y aceptando una imprecisi&#243;n m&#225;xima de &#177;<span class="elsevierStyleHsp" style=""></span>3&#37;&#44; con un nivel de confianza en la estimaci&#243;n del 95&#37;&#46; El tama&#241;o muestral m&#237;nimo calculado fue de 362 casos&#46; Los casos perdidos por cualquier causa se repusieron con el caso inmediatamente posterior&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Los datos recogidos se incluyeron en la aplicaci&#243;n inform&#225;tica SPSS 17&#46;0 &#40;SPSS Inc&#46; Released 2008&#46; SPSS Statistics for Windows&#44; Version 17&#46;0&#46; Chicago&#58; SPSS Inc&#46;&#41;&#46; El grado de concordancia interobservador de los entrevistadores sobre los mismos casos en la fase de entrenamiento previa se calcul&#243; mediante el &#237;ndice kappa&#44; determin&#225;ndose como acuerdo aceptable un &#237;ndice &#8805;<span class="elsevierStyleHsp" style=""></span>0&#44;80 &#40;80&#37;&#41;&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Se realiz&#243; un estudio univariante utilizando una distribuci&#243;n de frecuencias absolutas y relativas&#46; Las variables cuantitativas se expresaron con la media aritm&#233;tica o la mediana&#44; y su desviaci&#243;n est&#225;ndar &#40;DE&#41; o amplitud intercuartil &#40;AI&#41;&#44; respectivamente&#46; La distribuci&#243;n normal de los datos se determin&#243; por el test de Kolmogorov-Smirnov&#46; Para analizar la asociaci&#243;n de las variables cualitativas respecto a la variable dependiente &#171;dolor coronario&#58; s&#237;&#47;no&#187; se utiliz&#243; la prueba de la &#967;<span class="elsevierStyleSup">2</span>&#44; de significaci&#243;n bilateral&#44; con prueba exacta de Fisher en su caso&#44; consider&#225;ndose significativa una p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#46; La validez diagn&#243;stica se midi&#243; mediante el c&#225;lculo de la sensibilidad&#44; especificidad&#44; valor predictivo positivo &#40;VPP&#41;&#44; valor predictivo negativo &#40;VPN&#41;&#44; cocientes de probabilidad o <span class="elsevierStyleItalic">likelihood ratio</span> positivos &#40;CPP&#41; y negativos &#40;CPN&#41; y el valor diagn&#243;stico global<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">29</span></a>&#44; con sus respectivos intervalos de confianza del 95&#37; &#40;IC 95&#37;&#41;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">30</span></a>&#46;</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Resultados</span><p id="par0110" class="elsevierStylePara elsevierViewall">Se incluyeron 383 pacientes&#44; de los cuales 164 &#40;43&#37;&#41; correspondieron al grupo SCA y 219 &#40;57&#37;&#41; al de no SCA &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0115" class="elsevierStylePara elsevierViewall">El signo m&#225;s frecuentemente realizado fue el gesto 2&#44; globalmente &#40;60&#37;&#41; y por grupos diagn&#243;sticos &#40;60&#37; en el grupo SCA y 58&#37; en el grupo no SCA&#41;&#46; No hubo asociaci&#243;n estad&#237;sticamente significativa entre el tipo de gesto y el grupo diagn&#243;stico final &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;172&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46; El grupo no SCA&#44; en comparaci&#243;n con el SCA&#44; realiz&#243; con m&#225;s frecuencia gestos diferentes de los cl&#225;sicos 1&#44; 2 o 3 &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;030&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46; No hubo asociaci&#243;n entre el tipo de gesto y los diagn&#243;sticos espec&#237;ficos del grupo SCA &#40;&#225;ngor estable&#44; &#225;ngor inestable&#44; &#225;ngor hemodin&#225;mico e infarto agudo de miocardio&#41; &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;76&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0120" class="elsevierStylePara elsevierViewall">La validez diagn&#243;stica de los signos gestuales se expone en la <a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#46; Para el diagn&#243;stico de dolor coronario&#44; la mayor sensibilidad se obtuvo aisladamente por el gesto 2 &#40;60&#37;&#41;&#59; la mayor especificidad por el signo de Levine &#40;gesto 1&#41; &#40;90&#37;&#41;&#44; seguida de otros gestos &#40;86&#37;&#41; y del gesto 3 &#40;81&#37;&#41;&#46; No se registraron eventos coronarios o fallecimiento por causa coronaria de los pacientes durante el seguimiento&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Discusi&#243;n</span><p id="par0125" class="elsevierStylePara elsevierViewall">El presente estudio&#44; el tercero de este tipo reflejado en la literatura m&#233;dica revisada<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">11&#44;12</span></a> y el primero realizado en un SUH&#44; demuestra que la realizaci&#243;n por parte de los pacientes de determinados gestos con las manos no es &#250;til para determinar si el DTA es o no coronario&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Se considera que una prueba diagn&#243;stica tiene una validez aceptable si su sensibilidad y especificidad son iguales o superiores al 80&#37;<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">31</span></a>&#46; En nuestro estudio&#44; excepto el gesto 2&#44; los restantes signos considerados de manera aislada tuvieron una especificidad mayor del 80&#37;&#44; aunque una baja sensibilidad y valores predictivos&#44; e insuficiente precisi&#243;n diagn&#243;stica&#46; En t&#233;rminos de cocientes de probabilidad&#44; que son independientes de la prevalencia&#44; los resultados muestran valores de CPP ligeramente superiores a 1 para los gestos 1&#44; 2 y 3 &#40;1&#44;20 para el signo de Levine&#41;&#44; mientras que ninguno de los CPN fueron inferiores a 1&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Edmondstone<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">11</span></a> public&#243; en 1995 un breve art&#237;culo sobre la validez diagn&#243;stica del lenguaje de las manos en 203 pacientes con DTA de una unidad de cuidados coronarios&#46; El DTA fue coronario en 138 pacientes &#40;68&#37;&#41;&#44; y no coronario o indeterminado en 65 &#40;32&#37;&#41;&#44; con una elevada proporci&#243;n de pacientes coronarios respecto a nuestro estudio dada la procedencia de los mismos&#46; Su conclusi&#243;n fue que estos signos no son discriminativos para el diagn&#243;stico de dolor coronario&#46; No obstante&#44; bas&#225;ndose en una sensibilidad del 80&#37; y un VPP del 77&#37;&#44; concluyeron que la realizaci&#243;n de alguno de los 3 gestos podr&#237;a apoyar el diagn&#243;stico de SCA&#46; Estos resultados no son congruentes con nuestro estudio&#44; en donde el VPP fue solo del 45&#37; al considerar la realizaci&#243;n de cualquiera de los 3 signos frente a otros signos&#44; aunque la sensibilidad fue elevada &#40;93&#37;&#41;&#46; No obstante&#44; los CPP y CPN de nuestro estudio al considerar&#44; como hizo Edmondstone<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">11</span></a>&#44; la valoraci&#243;n conjunta de los gestos 1&#44; 2 o 3 &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41; demuestran la ausencia de validez diagn&#243;stica de estos signos&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">En el estudio de Marcus et al&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">12</span></a> sobre 202 pacientes ingresados en el hospital por DTA&#44; se explor&#243; el signo de Levine &#40;gesto 1&#41;&#44; el gesto 2 &#40;como en nuestro estudio&#41;&#44; y otros 2 signos distintos &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>D y E&#41;&#46; De los sujetos incluidos&#44; 107 &#40;53&#37;&#41; realizaron alguno de los 4 gestos&#58; el signo de Levine el 11&#37;&#44; el gesto 2 el 35&#37;&#44; el tercer gesto el 16&#37; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>D&#41; y el signo de la punta de dedo el 4&#37; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>E&#41;&#46; Tan solo la especificidad del signo de Levine &#40;84&#37;&#41; fue significativa&#44; similar a la de nuestro estudio &#40;89&#37;&#41;&#46; Al comparar los resultados alcanzados por estos 2 estudios previos y el actual &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a><span class="elsevierStyleBold">&#41;</span> se observa que&#44; aunque realizados en distintos &#225;mbitos&#44; no son demasiado dispares&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0145" class="elsevierStylePara elsevierViewall">Nuestro estudio no pretende simplificar el acto diagn&#243;stico a una simple expresi&#243;n corporal&#46; El diagn&#243;stico m&#233;dico requiere la integraci&#243;n de informaci&#243;n variada&#44; en ocasiones no bien establecida&#44; que incluye gestos&#44; posturas&#44; modos de expresi&#243;n verbal&#44; informaci&#243;n de los acompa&#241;antes&#44; entre otros muchos&#44; bas&#225;ndose en reglas y conclusiones heur&#237;sticas dif&#237;ciles de identificar&#46; Por ello&#44; raramente un diagn&#243;stico m&#233;dico &#40;o hip&#243;tesis diagn&#243;stica&#41; se basa en un &#250;nico aspecto de la historia cl&#237;nica o de la exploraci&#243;n f&#237;sica&#59; m&#225;s bien requiere integrar una informaci&#243;n compleja y variada para llegar a una conclusi&#243;n&#46; As&#237;&#44; no sorprende que en el presente estudio la expresividad del paciente&#44; considerada de forma aislada&#44; no aporte informaci&#243;n suficiente para alcanzar una conclusi&#243;n diagn&#243;stica segura&#46; &#218;nicamente se ha pretendido cuantificar la precisi&#243;n diagn&#243;stica de unos gestos que&#44; en alg&#250;n caso como el signo de Levine&#44; han sido considerados de utilidad en tratados cl&#225;sicos<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">13&#44;14&#44;15&#44;16&#44;17</span></a> y a&#250;n se siguen afirmando en algunos casos como de indiscutible valor semiol&#243;gico<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">32</span></a>&#44; incluso patognom&#243;nico&#44; de enfermedad coronaria&#46; Tampoco puede inferirse de este estudio que la manera en que se expresa el paciente no tenga inter&#233;s alguno&#46; Es un eslab&#243;n m&#225;s de una cadena que conduce finalmente a una conclusi&#243;n o hip&#243;tesis diagn&#243;stica&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Entre las limitaciones del estudio figuran el tipo de muestreo realizado&#44; por conglomerados&#59; que cada paciente fue entrevistado por solo un evaluador &#40;aunque el an&#225;lisis de concordancia previo minimiza esta limitaci&#243;n&#41;&#44; y que no todos los pacientes recibieron las mismas exploraciones para llegar al diagn&#243;stico final &#40;se realiz&#243; coronariograf&#237;a al 40&#37; de pacientes y angioTC coronario al 25&#37; del total de la muestra&#41;&#46; Adem&#225;s&#44; es posible que los pacientes diab&#233;ticos&#44; por su posible disautonom&#237;a&#44; pudiesen tener variaciones en la intensidad o localizaci&#243;n del dolor&#44; lo que implicar&#237;a un posible sesgo de selecci&#243;n&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Como conclusi&#243;n&#44; algunos signos que los pacientes con DTA realizan con las manos tienen una alta frecuencia &#40;89&#37;&#41;&#44; aunque no son &#250;tiles para determinar un posible origen coronario&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Conflicto de intereses</span><p id="par0160" 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">Objetivos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Comprobar la frecuencia de 3 gestos realizados con las manos por los pacientes con dolor tor&#225;cico y determinar su validez diagn&#243;stica en el s&#237;ndrome coronario agudo&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Pacientes y m&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Estudio prospectivo de 383 pacientes adultos asistidos en un servicio de urgencias por dolor tor&#225;cico&#46; Se observ&#243; la realizaci&#243;n de determinados signos gestuales con las manos&#44; previamente referidos en la literatura m&#233;dica como caracter&#237;sticos de dolor coronario &#40;gesto 1&#58; mano en pu&#241;o dispuesta sobre zona esternal o signo de Levine&#59; gesto 2&#58; mano abierta situada en la misma localizaci&#243;n&#59; gesto 3&#58; ambas manos colocadas en el centro del t&#243;rax&#41;&#44; as&#237; como la de otros gestos&#46; Se analiz&#243; su asociaci&#243;n con el origen coronario del dolor&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">En 164 &#40;43&#37;&#41; pacientes se confirm&#243; el origen coronario del dolor &#40;grupo SCA&#41;&#44; y en 219 &#40;57&#37;&#41; no se confirm&#243; &#40;grupo no SCA&#41;&#46; Un 89&#37; de pacientes identificaron su dolor con alguno de los 3 gestos cl&#225;sicos&#46; El m&#225;s frecuente fue el 2&#44; tanto globalmente &#40;59&#37;&#41; como por grupos &#40;60&#37; grupo SCA&#59; 57&#44;5&#37; grupo no SCA&#41;&#46; No hubo asociaci&#243;n significativa entre el tipo de gesto realizado y el diagn&#243;stico final &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;172&#41;&#46; La mayor especificidad correspondi&#243; al signo de Levine &#40;90&#37;&#41;&#44; seguida de otros gestos &#40;86&#37;&#41; y del gesto 3 &#40;81&#37;&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Aunque el 89&#37; de los pacientes expresaron el dolor tor&#225;cico con alguno de los 3 gestos manuales cl&#225;sicamente asociados al dolor coronario&#44; ninguno de ellos alcanz&#243; suficiente precisi&#243;n diagn&#243;stica para ser utilizado como indicativo de este tipo de dolor&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objectives</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">To determine the frequency of 3 hand gestures by patients with chest pain and determine the diagnostic validity of the gestures in acute coronary syndrome&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Patients and methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">A prospective study was conducted on 383 adult patients treated for chest pain in an emergency department&#46; We observed certain hand gestures&#44; previously referred to in the medical literature as characteristic of coronary pain &#40;gesture 1&#58; a clenched fist held over the sternal area or Levine&#39;s sign&#59; gesture 2&#58; open hand located over the same area&#59; gesture 3&#58; both hands placed in the centre of the chest&#41;&#44; as well as other gestures&#46; We analysed their association with the coronary origin of the pain&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">We confirmed the coronary origin of the pain in 164 &#40;43&#37;&#41; patients &#40;ACS group&#41;&#46; The other 219 patients &#40;57&#37;&#41; did not have a coronary origin for the pain &#40;nonACS group&#41;&#46; Eighty-nine percent of the patients identified their pain with one of the 3 classical gestures&#46; The most frequent gesture was number 2&#44; both overall &#40;59&#37;&#41; and by group &#40;60&#37; ACS group&#59; 57&#46;5&#37; nonACS group&#41;&#46; There was no significant association between the type of gesture and the final diagnosis &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;172&#41;&#46; The greater specificity corresponded to Levine&#39;s sign &#40;90&#37;&#41;&#44; followed by other gestures &#40;86&#37;&#41; and gesture 3 &#40;81&#37;&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Although 89&#37; of the patients expressed their chest pain with one of the 3 manual gestures classically associated with coronary pain&#44; none achieved sufficient diagnostic accuracy to be used as indicative of this type of pain&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Objectives"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Patients and methods"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusions"
          ]
        ]
      ]
    ]
    "multimedia" => array:8 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figura 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1995
            "Ancho" => 3000
            "Tamanyo" => 521383
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        ]
        "descripcion" => array:1 [
          "es" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">A&#41; Signo de Levine&#58; mano en pu&#241;o en el centro del t&#243;rax&#46; B&#41; Mano extendida en el centro del t&#243;rax&#46; C&#41; Ambas manos colocadas en el centro del t&#243;rax desplaz&#225;ndolas hacia fuera &#40;explorados por Edmondstone<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">11</span></a> en 1995&#41;&#46; D y E&#41; Otros signos de las manos explorados por Marcus et al&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">12</span></a>&#46;</p>"
        ]
      ]
      1 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Tabla 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Tabla "
            "rol" => "short"
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        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">AHA&#58; <span class="elsevierStyleItalic">American Heart Association</span>&#59; AI&#58; amplitud intercuartil&#59; BCRI&#58; bloqueo completo de rama izquierda&#59; ECG&#58; electrocardiograma&#59; ORL&#58; origen otorrinolaringol&#243;gico&#59; SCA&#58; s&#237;ndrome coronario agudo&#59; ST&#58; segmento ST&#59; UCI&#58; unidad de cuidados intensivos&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " rowspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variables</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Pacientes</th></tr><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Total n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>383&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Edad &#40;AI&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">66 &#40;23&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Sexo</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Var&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">211&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">55&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Mujer&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">172&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Tiempo de evoluci&#243;n del dolor en horas &#40;AI&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#44;56 &#40;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Clasificaci&#243;n de riesgo coronario de la AHA seg&#250;n hallazgos ECG</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Con elevaci&#243;n ST o nuevo BCRI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Con descenso ST o inversi&#243;n din&#225;mica de la onda T&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>ECG no diagn&#243;stico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">329&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">86&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Juicio diagn&#243;stico sobre el dolor reflejado en urgencias</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Card&#237;aco&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">181&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">47&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No card&#237;aco&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">134&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">82&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Origen incierto&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">68&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Ingreso en observaci&#243;n</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">191&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">192&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Destino del paciente</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Domicilio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">228&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Planta de cardiolog&#237;a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">117&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>UCI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Otros&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Diagn&#243;stico final dolor de origen coronario &#40;grupo SCA&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#193;ngor estable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#193;ngor inestable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">85&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Infarto agudo de miocardio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">39&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#193;ngor hemodin&#225;mico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Total grupo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">164&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Dolor de origen no coronario &#40;grupo no SCA&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Peric&#225;rdico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Pulmonar&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Digestivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Musculoesquel&#233;tico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Psic&#243;geno&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>ORL &#40;faringolar&#237;ngeo&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Indeterminado&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">119&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Total grupo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">219&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1427028.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "es" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Caracter&#237;sticas generales de la cohorte</p>"
        ]
      ]
      2 => array:8 [
        "identificador" => "tbl0010"
        "etiqueta" => "Tabla 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at2"
            "detalle" => "Tabla "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">&#8595; &#37;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>porcentaje respecto a columnas&#59; &#8594; &#37;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>porcentaje respecto a filas&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " rowspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Modalidad de realizaci&#243;n gestual</th><th class="td" title="table-head  " rowspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Gesto realizado por el paciente</th><th class="td" title="table-head  " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Dolor coronario</th><th class="td" title="table-head  " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Dolor no coronario</th><th class="td" title="table-head  " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Total</th><th class="td" title="table-head  " rowspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Valor de p</th></tr><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">&#8595; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">&#8594;&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">&#8595; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">&#8594; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">&#8595; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">&#8594;&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " rowspan="5" align="center" valign="middle">Tipo de gesto</td><td class="td" title="table-entry  " align="left" valign="top">Gesto 1 &#40;Levine&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">47&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">52&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="5" align="center" valign="middle">0&#44;172</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Gesto 2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">99&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">60&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">44&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">126&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">57&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">56&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">225&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">58&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Gesto 3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">45&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">41&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">18&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">54&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">75&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">19&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Otros gestos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">73&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">41&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">164&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">42&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">219&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">57&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">383&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="3" align="center" valign="middle">Gestos 1&#44; 2 o 3 vs&#46; otros gestos</td><td class="td" title="table-entry  " align="left" valign="top">Gesto 1&#44; 2 o 3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">153&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">93&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">44&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">189&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">86&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">55&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">342&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">89&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="3" align="center" valign="middle">0&#44;030</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Otros gestos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">73&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">41&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">164&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">42&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">219&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">57&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">383&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1427029.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "es" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Distribuci&#243;n de casos seg&#250;n el gesto realizado</p>"
        ]
      ]
      3 => array:8 [
        "identificador" => "tbl0015"
        "etiqueta" => "Tabla 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at3"
            "detalle" => "Tabla "
            "rol" => "short"
          ]
        ]
        "tabla" => array:3 [
          "leyenda" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">IC 95&#37;&#58; intervalos de confianza del 95&#37;&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " rowspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Validez diagn&#243;stica</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Gesto 1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Gesto 2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Gesto 3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Otros gestos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Gestos 1&#44; 2 o 3 vs&#46; otros gestos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Valor &#40;IC 95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Valor &#40;IC 95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Valor &#40;IC 95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Valor &#40;IC 95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Valor &#40;IC 95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Sensibilidad&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&#44;2 &#40;8-18&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">60&#44;4 &#40;52&#44;7-67&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&#44;7 &#40;15&#44;2-27&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#44;7 &#40;3&#44;8-11&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">93&#44;3 &#40;88&#44;4-96&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Especificidad&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">90 &#40;85-93&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">42&#44;5 &#40;36&#44;1-49&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">81&#44;3 &#40;75&#44;6-85&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">86&#44;3 &#40;81&#44;1-90&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&#44;7 &#40;9&#44;8-18&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Valor predictivo positivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">45&#44;5 &#40;32-60&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">44 &#40;37&#44;7-50&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">45&#44;3 &#40;34&#44;6-56&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26&#44;8 &#40;15&#44;7-41&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">44&#44;7 &#40;39&#44;6-50&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Valor predictivo negativo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">58 &#40;52&#44;5-63&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">58&#44;9 &#40;51&#44;0-66&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">57&#44;8 &#40;52&#44;2-63&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">55&#44;3 &#40;50-60&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">73&#44;2 &#40;58&#44;1-84&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cociente de probabilidad positivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;2 &#40;0&#44;7-2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;1 &#40;0&#44;90-1&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;1 &#40;0&#44;8-1&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;5 &#40;0&#44;3-0&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;1 &#40;1-1&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cociente de probabilidad negativo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;98 &#40;0&#44;9-1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;93 &#40;0&#44;7-1&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;98 &#40;0&#44;9-1&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;1 &#40;1-1&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;5 &#40;0&#44;3-0&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Valor diagn&#243;stico global&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">57 &#40;52-61&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50&#44;1 &#40;45&#44;2-55&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">55&#44;3 &#40;50&#44;4-60&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">52&#44;2 &#40;47&#44;2-57&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">47&#44;8 &#40;42&#44;8-52&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "leyenda" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">&#8211;&#58; ausencia de datos o imposibilidad de extraerlos del art&#237;culo&#59; VPN&#58; valor predictivo negativo&#59; VPP&#58; valor predictivo positivo&#46;</p><p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">Se prescinde de cifras decimales porque el estudio de Marcus et al&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">12</span></a> no las proporciona&#46; Se ha aproximado el decimal a la unidad m&#225;s cercana&#46; No se dispone de las <span class="elsevierStyleItalic">likelihood ratio</span> o cocientes de probabilidad de los estudios a comparar&#46;</p><p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">Los datos entre par&#233;ntesis corresponden a los intervalos de confianza al 95&#37;&#46;</p>"
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " rowspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Signo</th><th class="td" title="table-head  " rowspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Test</th><th class="td" title="table-head  " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Estudios realizados<br>Autor&#44; n&#250;mero de pacientes y &#225;mbito</th></tr><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Edmondstone<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">11</span></a>&#44; 203 pacientes de unidad coronaria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Marcus et al&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">12</span></a>&#44; 202 pacientes de cardiolog&#237;a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Estudio actual&#44; 383 pacientes del servicio de urgencias&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " rowspan="5" align="left" valign="top">Gesto 1 &#40;Signo de Levine&#41; <elsevierMultimedia ident="201705300032536171"></elsevierMultimedia></td><td class="td" title="table-entry  " align="left" valign="top">Prevalencia&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Sensibilidad&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14 &#40;9-20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9 &#40;5-17&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12 &#40;8-18&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Especificidad&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">89 &#40;79-55&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">84 &#40;72-92&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">90 &#40;85-93&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">VPP&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">73 &#40;54-86&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50 &#40;27-73&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">45 &#40;32-60&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">VPN&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">32 &#40;26-40&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">31 &#40;28-44&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">58 &#40;52-63&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="5" align="left" valign="top">Gesto 2 <elsevierMultimedia ident="201705300032536172"></elsevierMultimedia></td><td class="td" title="table-entry  " align="left" valign="top">Prevalencia&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">59&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Sensibilidad&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">46 &#40;38-55&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">38 &#40;28-48&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">60 &#40;53-68&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Especificidad&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">74 &#40;62-83&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">67 &#40;54-78&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">42 &#40;36-49&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">VPP&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">79 &#40;69-86&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">65 &#40;52-77&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">44 &#40;38-51&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">VPN&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">39 &#40;31-48&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">39 &#40;30-49&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">59 &#40;51-66&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="5" align="left" valign="top">Gesto 3 <elsevierMultimedia ident="201705300032536173"></elsevierMultimedia></td><td class="td" title="table-entry  " align="left" valign="top">Prevalencia&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Sensibilidad&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20 &#40;14-27&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21 &#40;15-28&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Especificidad&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">86 &#40;76-92&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">81 &#40;76-86&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">VPP&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">75 &#40;59-86&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">45 &#40;35-57&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">VPN&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">33 &#40;27-41&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">58 &#40;52-63&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="6" align="left" valign="top">Otros gestos</td><td class="td" title="table-entry  " align="left" valign="top">Prevalencia&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Sensibilidad&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21 &#40;14-28&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
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Información del artículo
ISSN: 00142565
Idioma original: Español
DOI:10.1016/j.rce.2017.02.019
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