Paediatric dermatology emergencies in a tertiary hospital

array:24 ["pii" => "S2341287915001714" "issn" => "23412879" "doi" => "10.1016/j.anpede.2015.09.008" "estado" => "S300" "fechaPublicacion" => "2015-12-01" "aid" => "1803" "copyright" => "Asociación Española de Pediatría" "copyrightAnyo" => "2014" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "An Pediatr (Barc). 2015;83:397-403" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 2157 "formatos" => array:3 [ "EPUB" => 152 "HTML" => 1531 "PDF" => 474 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S1695403315000375" "issn" => "16954033" "doi" => "10.1016/j.anpedi.2015.01.001" "estado" => "S300" "fechaPublicacion" => "2015-12-01" "aid" => "1803" "copyright" => "Asociación Española de Pediatría" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "An Pediatr (Barc). 2015;83:397-403" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 5520 "formatos" => array:3 [ "EPUB" => 124 "HTML" => 3514 "PDF" => 1882 ] ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "ORIGINAL" "titulo" => "Urgencias dermatológicas pediátricas en un hospital de tercer nivel" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "397" "paginaFinal" => "403" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Paediatric dermatology emergencies in a tertiary hospital" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 777 "Ancho" => 1577 "Tamanyo" => 59228 ] ] "descripcion" => array:1 [ "es" => "Distribución por edad." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "E. Baquero-Sánchez, J. Bernabéu-Wittel, J.J. Dominguez-Cruz, J. Conejo-Mir" "autores" => array:4 [ 0 => array:2 [ "nombre" => "E." "apellidos" => "Baquero-Sánchez" ] 1 => array:2 [ "nombre" => "J." "apellidos" => "Bernabéu-Wittel" ] 2 => array:2 [ "nombre" => "J.J." "apellidos" => "Dominguez-Cruz" ] 3 => array:2 [ "nombre" => "J." "apellidos" => "Conejo-Mir" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2341287915001714" "doi" => "10.1016/j.anpede.2015.09.008" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287915001714?idApp=UINPBA00005H" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1695403315000375?idApp=UINPBA00005H" "url" => "/16954033/0000008300000006/v1_201512060011/S1695403315000375/v1_201512060011/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2341287915001866" "issn" => "23412879" "doi" => "10.1016/j.anpede.2015.09.015" "estado" => "S300" "fechaPublicacion" => "2015-12-01" "aid" => "1804" "copyright" => "Asociación Española de Pediatría" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "An Pediatr (Barc). 2015;83:404-9" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 1825 "formatos" => array:3 [ "EPUB" => 129 "HTML" => 1212 "PDF" => 484 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "Original Article" "titulo" => "Long-term outcomes of children treated with continuous renal replacement therapy" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "404" "paginaFinal" => "409" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Evolución a largo plazo de los niños tratados con técnicas de depuración extrarrenal continua" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 973 "Ancho" => 1572 "Tamanyo" => 68452 ] ] "descripcion" => array:1 [ "en" => "Creatinine progress (median and interquartile range) throughout evolution. CRRT: continuous extrarenal depuration technique." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "S. Almarza, K. Bialobrzeska, M.M. Casellas, M.J. Santiago, J. López-Herce, B. Toledo, Á. Carrillo" "autores" => array:7 [ 0 => array:2 [ "nombre" => "S." "apellidos" => "Almarza" ] 1 => array:2 [ "nombre" => "K." "apellidos" => "Bialobrzeska" ] 2 => array:2 [ "nombre" => "M.M." "apellidos" => "Casellas" ] 3 => array:2 [ "nombre" => "M.J." "apellidos" => "Santiago" ] 4 => array:2 [ "nombre" => "J." "apellidos" => "López-Herce" ] 5 => array:2 [ "nombre" => "B." "apellidos" => "Toledo" ] 6 => array:2 [ "nombre" => "Á." "apellidos" => "Carrillo" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S1695403315000387" "doi" => "10.1016/j.anpedi.2014.12.018" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1695403315000387?idApp=UINPBA00005H" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287915001866?idApp=UINPBA00005H" "url" => "/23412879/0000008300000006/v2_201601190027/S2341287915001866/v2_201601190027/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2341287915001908" "issn" => "23412879" "doi" => "10.1016/j.anpede.2015.09.018" "estado" => "S300" "fechaPublicacion" => "2015-12-01" "aid" => "1809" "copyright" => "Asociación Española de Pediatría" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "An Pediatr (Barc). 2015;83:387-96" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 2808 "formatos" => array:3 [ "EPUB" => 150 "HTML" => 2025 "PDF" => 633 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "Original Article" "titulo" => "Development and validation of a Breastfeeding Knowledge and Skills Questionnaire" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "387" "paginaFinal" => "396" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Validación de un cuestionario sobre conocimientos y habilidades en lactancia materna" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1437 "Ancho" => 1582 "Tamanyo" => 75081 ] ] "descripcion" => array:1 [ "en" => "Group scoring. Box and whisker plot. For each group, a box represents the interquartile range (IQR), the centre line represents the median, and the notches the 95% confidence interval of the median. The upper and lower whiskers reach respectively the maximum or minimum value at a distance of 1.5*IQR from the box. Extreme values are represented individually. The thick horizontal line at 70% represents sufficient." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M. Gómez Fernández-Vegue, M. Menéndez Orenga" "autores" => array:2 [ 0 => array:2 [ "nombre" => "M." "apellidos" => "Gómez Fernández-Vegue" ] 1 => array:2 [ "nombre" => "M." "apellidos" => "Menéndez Orenga" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S1695403315000442" "doi" => "10.1016/j.anpedi.2015.01.006" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1695403315000442?idApp=UINPBA00005H" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287915001908?idApp=UINPBA00005H" "url" => "/23412879/0000008300000006/v2_201601190027/S2341287915001908/v2_201601190027/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "Original Article" "titulo" => "Paediatric dermatology emergencies in a tertiary hospital" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "397" "paginaFinal" => "403" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "E. Baquero-Sánchez, J. Bernabéu-Wittel, J.J. Dominguez-Cruz, J. Conejo-Mir" "autores" => array:4 [ 0 => array:4 [ "nombre" => "E." "apellidos" => "Baquero-Sánchez" "email" => array:1 [ 0 => "elena_baquero@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "J." "apellidos" => "Bernabéu-Wittel" ] 2 => array:2 [ "nombre" => "J.J." "apellidos" => "Dominguez-Cruz" ] 3 => array:2 [ "nombre" => "J." "apellidos" => "Conejo-Mir" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Dermatología, Hospital Universitario Virgen del Rocío, Sevilla, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Urgencias dermatológicas pediátricas en un hospital de tercer nivel" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 942 "Ancho" => 1570 "Tamanyo" => 58150 ] ] "descripcion" => array:1 [ "en" => "Distribution of mucocutaneous infections." ] ] ] "textoCompleto" => "IntroductionIn the last years, several studies have been published on dermatological emergencies in our area, all except one concerning the general population.<a class="elsevierStyleCrossRefs" href="#bib0090">1–8</a> The increasing interest in this issue is mainly derived from the progressive increase in the demand for assistance in hospital emergency services, up to the point that an annual increase of 10–20% is calculated for emergency assistance.<a class="elsevierStyleCrossRefs" href="#bib0130">9,10</a>This growth is mainly due to minor diseases. At the same time, emergency dermatological cases have not been the exception to that increasing trend. It is estimated that the emergency dermatological demand represents 8–10% of the total emergency cases at a general hospital, and up to 10.2% in the paediatric population.<a class="elsevierStyleCrossRefs" href="#bib0140">11,12</a>The main factors involved in this improper use of hospital emergencies are the lack of trust in primary care, lack of health education and waiting lists,<a class="elsevierStyleCrossRefs" href="#bib0130">9,13–15</a> with the added aspect in dermatology of the spectacular nature of skin signs and symptoms, which create huge anxiety in the patient or, more frequently during the paediatric age, their relatives.The main goal of the study was to describe the profile of the user and determine the frequency of the various dermatological diagnoses referred by the paediatrician on duty and attended to the emergency paediatric dermatological office, since most prior studies refer to the general population<a class="elsevierStyleCrossRefs" href="#bib0090">1–8</a> and it is not possible to extrapolate the results to this subgroup, where we know there are changes in the frequencies of diagnoses.<a class="elsevierStyleCrossRef" href="#bib0110">5</a> As a secondary goal, we aimed to analyse the resolution capacity of the dermatologist on duty, as well as the profitability of emergency paediatric dermatological consultation.Materials and methodsThe study was carried out in a third-level hospital with 100 beds, 115 of those in the Children's Hospital, covering an area of 554,981 inhabitants, 16% of whom are the paediatric population.This hospital has a dermatology resident on duty Mondays to Fridays to cover general dermatological emergencies, 3–8pm, and 2 days of the week, Mondays and Thursdays, with the help of a second resident (third or fourth year) for assistance at the dermatological emergency office, also 3–8pm. In this way, all patients 0–14 years old attending the Casualty Department for dermatological reasons are previously examined by the paediatrician on duty or paediatrics resident, who may, if necessary, call the dermatologist for urgent cases.A retrospective study was designed based on the data collected from clinical records of all patients attending paediatric dermatological emergencies from June 2010 to December 2013, a total of 861 patients.Emergency attendance sheets were reviewed as part of the work protocol when the patient is discharged and referred to dermatological emergencies, and the subsequent medical history at that consultation. The following data were gathered for each patient: name and surname, age, gender, date of attendance, supplementary evidence requested, destination upon discharge and diagnosis, both that of the paediatrician in the discharge report and the subsequent diagnosis by the Dermatology resident.To facilitate the development of the study, the data were collected as stated in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>First, a descriptive study of the observed characteristics of patients was carried out. For qualitative variables, the absolute frequency of each category and percentages were used; for quantitative variables, the mean, median, standard deviation and range were used. In contrast, if the quantitative variables followed a normal distribution, the Kolmogorov–Smirnov test was used. Secondly, an analytical study was carried out by preparing contingency tables and calculating the kappa index, to establish the diagnosis concordance between the diagnosis upon discharge previously issued at the General Paediatric Emergency Department and the dermatology diagnosis.The statistical analysis was carried out using version 18.0 of the statistical software Statistical Package for the Social Sciences (SPSS Inc., Chicago, IL, USA). All confidence intervals calculated were at 95%, and all p values were calculated bilaterally, considering values below 0.05 as statistically significant.ResultsDuring the period of the study, 861 patients were called to consultation, after excluding revisits (patients who attended again for the same reason they had been assessed for at the Casualty Department and the consultation at the Dermatological Emergency Department). A mean of 20 patients a month were attended to, observing a higher attendance volume during October (24.3 patients/month), April (24 patients/month) and May (24 patients/month).Of the 861 patients attended to, 466 (54%) were boys and 395 (46%) girls (there are no statistically significant differences). The mean age was 4.5±4 years, the median, 3 years, and the mode, 0 years (from birth to 11 months) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Regarding the distribution by age groups, the population with the highest demand were pre-schoolers (31%), followed by school-aged children (27%), infants (18%), early childhood (15%) and lastly children in puberty (9%).<elsevierMultimedia ident="fig0005"></elsevierMultimedia>By diagnosis groups (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>), eczema (27%) and infections (26%) were the main reasons for consultation, together representing more than half the consultations. Following those in terms of frequency, erythematous dermatitis (7%), bites/prurigo simplex (7%), tumours (6%) and the miscellaneous group (5%). This last group included various diagnoses related to the paediatric age, such as mastocytosis, histiocytosis, enteropathic acrodermatitis and toxic erythema in the new-born. Forty-one patients (5%) did not attend their appointments at the Emergency Paediatric Dermatology Department and for three patients no diagnosis was issued after attendance.<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>Within the infections group, 111 (50%) were of viral origin, 50 (22%) of fungal origin, 40 (18%) of bacterial origin, and, lastly, 22 (10%) of parasitic origin (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>), while in the eczema group, 141 (62%) were due to atopic dermatitis, followed in frequency by seborrheic dermatitis in 23 patients (10%) and contact dermatitis in 20 (9%) (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).<elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia>As reflected in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>, these groups of diseases were also analysed based on the age groups, showing differences in the frequencies of the diseases within the different groups.Regarding the diagnosis made, 66% of consultations were for 18 diseases (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>). However, a total of 108 different diagnoses were issued. Out of those, the main individual processes were: atopic dermatitis (16%), acute prurigo simplex (5%), dermatophytosis (5%), pyogenic granuloma (4%), molluscum contagious (4%) and impetigo (4%).<elsevierMultimedia ident="tbl0015"></elsevierMultimedia>Regarding the consumption of supplementary tests, these were only required for 166 patients (16%); the one requested most frequently was microbiological culture (35%), followed by blood test with haemogram and biochemical (22%), serology (10%), skin biopsy (10%), CRP for herpesviridae (8%), immunology study (5%) and imaging tests (4%) (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>). In the group called “Others”, electrocardiograms and specific analytical determinations were included, such as cinquemia, serum triptase, etc.<elsevierMultimedia ident="fig0020"></elsevierMultimedia>Regarding destination after attendance, 48% of patients were directly discharged without the need for further consultations; 43% were referred to consultation to the ordinary Paediatric Dermatology Department; 6% of patients were referred by their GP and a later assessment by their dermatologist. In “other destinations” (2%), referrals to other consultants and their hospitals of reference were included. The resulting admission rate was 1% and included five children admitted with the following diagnoses: two due to infant haemorrhagic oedema, two due to eczema herpeticum and one due to disseminated herpes zoster in an immunocompromised patient.When analysing all Casualty Department discharge reports of patients who were afterwards transferred to the Emergency Dermatology Department, it was observed that in 67% of the discharge there was a specific clinical judgement by the paediatrician, in 20% a descriptive diagnosis based on element lesions, and in 13% of the reports there was no dermatology diagnosis.For the purposes of establishing diagnosis concordance among those cases where a specific clinical judgement was reached in the Casualty Department and afterwards assessment in the consultation by the Emergency Paediatric Dermatology Department, a contingency table was prepared whereby a kappa index of 0.206 was obtained (95% CI: 0.170–0.241).DiscussionAlthough dermatology has been considered as a specialisation with no emergency service, it cannot be denied that the number of patients requesting immediate care in the Emergency Departments due to dermatological reasons represents a significant percentage of the total, with an estimated 8–10%.<a class="elsevierStyleCrossRefs" href="#bib0140">11,12</a> As expected, most of these consultations are not for truly serious diseases or diseases which may put the patient's life at risk.<a class="elsevierStyleCrossRefs" href="#bib0090">1–8</a> However, this increase in the demand for care in hospital Emergency Departments mainly due to minor complaints is not exclusive to dermatology, since it has been estimated that between one and two-thirds of the total consultations in Paediatric Emergency Departments are due to minor diseases.<a class="elsevierStyleCrossRefs" href="#bib0155">14,15</a>However, whether or not skin diseases are serious, there are other determinants leading the patient (or the relative, in this case) to attend the Casualty Department, such as the spectacular nature of the signs and symptoms (especially pruritus), the lack of information, doubts on whether the condition is transmissible, etc.Due to the differences among health systems of each country, our discussion is based on prior studies carried out in Spain's public health system.<a class="elsevierStyleCrossRefs" href="#bib0090">1–8</a> Thus, the mean age obtained in our study (4.5 years) was lower than that found in the study carried out by Roca Saurina et al.<a class="elsevierStyleCrossRef" href="#bib0110">5</a> and that stated by Colomés et al.,<a class="elsevierStyleCrossRef" href="#bib0145">12</a> who refer the highest volume of attendance in ages 6 and 7. In fact, the patients with most consultations in our case were 0 to 1 year. Although the age groups created are heterogeneous as regard the period included (for instance, the group of infants includes from 0 to one year and the group of school-aged children 6–12 years), we think the information on the distribution of patients in the different stages is of interest, taking into consideration the large clinical and physiological variability in these relatively short periods of time (differences are evident between, for instance, an infant and a school-aged child).As regards gender, studies on the general population have reported female predominance;<a class="elsevierStyleCrossRef" href="#bib0115">6</a> however, in our study, as in the study by Roca Saurina et al.,<a class="elsevierStyleCrossRef" href="#bib0110">5</a> no significant gender differences were shown.When analysing the main diagnosis groups and comparing them with those obtained by other authors, we noted that infections were the main diagnosis groups in all studies, followed by eczema/dermatitis.<a class="elsevierStyleCrossRefs" href="#bib0090">1–8</a> In our case, the frequency of both groups was very similar, which we think is because in our study the mean age was lower and we attended to a larger number of infants, who often attend due to atopic dermatitis and other eczema.The group of bites/prurigo was third in terms of frequency in children, as already described,<a class="elsevierStyleCrossRef" href="#bib0110">5</a> while in the general population this position was occupied by the group of urticaria/angioedema.<a class="elsevierStyleCrossRefs" href="#bib0090">1–4,6</a>Regarding infections, the ones with the highest prevalence were those of viral origin (50% overall), matching the data obtained by Roca Saurina et al.<a class="elsevierStyleCrossRef" href="#bib0110">5</a>; but different from the data obtained in adults, where there is a predominance of bacterial origin.<a class="elsevierStyleCrossRefs" href="#bib0090">1–4,6</a> However, in our work fungal infections were second in terms of frequency (22%), followed by bacterial infections (18%), while in the work by Roca Saurina et al.<a class="elsevierStyleCrossRef" href="#bib0110">5</a> bacterial infections were second in terms of frequency, followed by fungal infections. This difference may be due to the fact that in our case the dermatologist does not attend the Emergency room daily, and the patient has to be called to attend, and the paediatrician attends to the dermatological disease more frequently. In the case of eczema, both in our study and that carried out by Roca Saurina et al.,<a class="elsevierStyleCrossRef" href="#bib0110">5</a> the most frequent cause is atopic dermatitis, while in adults it is contact dermatitis.<a class="elsevierStyleCrossRef" href="#bib0115">6</a>As regards the distribution of diagnosis groups, it is noteworthy how the frequencies of the diseases are modified in the different intervals, in such a way that the group of infants was the one most different from the general population. As the age of the patient increased, the diagnoses were more and more similar to those of the general population.<a class="elsevierStyleCrossRef" href="#bib0110">5</a> In fact, in the infants group, the percentage of eczema was much higher than in the other groups (36% overall in relation to 16% in children in puberty), mainly due to the higher frequency of atopic dermatitis in that population. It is noteworthy that 12% of the consultations in infants were due to vascular anomalies. In our study, unlike the earlier ones, we decided to differentiate this group, where vascular malformations and vascular tumours are included, mainly child haemangiomas and their complications, in the group of tumours because there are differences in management in relation to other tumours and because the centre has a specific Child Vascular Anomalies unit. The miscellaneous group was third in terms of frequency in this group, and included diseases typical of paediatric age, as already mentioned.In early childhood (1–2 years) there is still a predominance, although less pronounced, of eczema (31% overall), and consultations due to infections almost doubled (23%). There was also a significant increase in this group of consultations due to bites and prurigo (11%), and a 2% drop in consultations due to vascular anomalies, as expected.In pre-schoolers and school-aged children, infections and eczema continued to be the main causes of demand for care, but infections become more frequent than eczema. This inversion is due to the fact that, on the one hand, there was a decrease in some types of eczema, such as seborrheic dermatitis and atopic dermatitis, and, on the other, the increase in infections, mainly those of viral origin. In addition, the increase of consultations for other causes, such as erythematous dermatitis, with frequencies four times above those observed in the prior groups.Lastly, in children in puberty infections continue to have predominance over eczema, but the frequency in both groups decreased and other groups become relevant, such as the tumours group (8% overall), with a large part of these consultations caused by pyogenic granulomas which may cause significant clinical symptoms, such as bleeding and rapid growth. It is worth noting the relevant difference obtained when comparing the frequencies of the urticaria and angioedema categories in the group of children in puberty according to the data published by Roca Saurina et al.<a class="elsevierStyleCrossRef" href="#bib0110">5</a> and ours. In their case, urticaria/angioedema represented 30% of emergency consultations in this age group, while in our case it was 3%. We again attribute this marked difference to the system for calling patients to attend and the role of the paediatrician as a filter, who, except in atypical or torpid progression cases, usually has no trouble with the diagnosis and initial management of this disease.As regards the resolution capacity of the dermatologist on duty, we noted how in our study the consumption of supplementary tests was low, data similar to those found by Grillo et al.<a class="elsevierStyleCrossRef" href="#bib0115">6</a> Also, the most requested test was microbiological culture, a test that is easy to carry out, affordable and not at all aggressive. The percentage of skin biopsies was far below those carried out in adults.<a class="elsevierStyleCrossRef" href="#bib0115">6</a> Almost half of the patients were directly discharged without the need for supplementary tests. Most cases transferred to child dermatology were carried out with a diagnosis and a treatment line already started.The global concordance between the diagnoses issued by the family doctor and the dermatologist is, according to some studies, 40–60%.<a class="elsevierStyleCrossRefs" href="#bib0165">16,17</a> In our study the concordance percentage was 57% and the kappa index 0.206 (95% CI: 0.170–0.241), reflecting a scarce correlation. The interpretation of these data has a series of limitations, such as that only cases where both the paediatrician and the dermatologist have issued a diagnosis can be included, and that we only included cases attended to in the Emergency Paediatric Dermatology Department and who, therefore, have posed a question or enquiry to the paediatrician, and not all those who were actually assessed in the Casualty Department.ConclusionsIt has been widely proven that pathological dermatology processes cause a large health care demand in Emergency Departments globally, and especially high during the paediatric age. Although most consultations were not due to serious diseases, these were perceived by parents as alarming, and there is a small percentage of diseases which do pose a real danger for the life of the child in the short term, such as eczema herpeticum or vasculitis, where the dermatologist on duty plays an important role both in the diagnosis and management. On the other hand, the dermatologist on duty offers a high resolution capacity regarding the low percentage of supplementary tests requested and the number of direct discharges. Lastly, carrying out epidemiology studies like the one presented would provide a better understanding of the clinical dermatological reality we attend to, and would allow us to prepare training plans for residents and paediatricians for the purpose of improving health care quality.Conflict of interestsThe authors declare that there are no conflicts of interest." "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres597267" "titulo" => "Abstract" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Objectives" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Materials and methods" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Results" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec611983" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres597268" "titulo" => "Resumen" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0030" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0035" "titulo" => "Objetivos" ] 2 => array:2 [ "identificador" => "abst0040" "titulo" => "Material y métodos" ] 3 => array:2 [ "identificador" => "abst0045" "titulo" => "Resultados" ] 4 => array:2 [ "identificador" => "abst0050" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec611982" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Materials and methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conclusions" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Conflict of interests" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2014-10-02" "fechaAceptado" => "2015-01-09" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec611983" "palabras" => array:3 [ 0 => "Emergencies" 1 => "Paediatric dermatology" 2 => "Epidemiology" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec611982" "palabras" => array:3 [ 0 => "Urgencias" 1 => "Dermatología pediátrica" 2 => "Epidemiología" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "IntroductionIn recent years, the increasing demand for dermatological consultations in the Emergency Department has resulted in the publication of a variety of studies on this subject. However, most of them deal with the general population, without taking into account the changes in frequencies found in young children (ages 0–14). ObjectivesTo determine the frequency of various dermatological diagnoses made by the on-call paediatrician in the Emergency Department, and after referral to paediatric dermatology. Materials and methodsFirstly, a descriptive retrospective study was performed that included all patients aged between 0 and 14 years old who were seen after being referred to the emergency paediatric dermatologist by the on-call paediatrician from June 2010 to December 2013. Secondly, an analytical study was carried out by calculating the kappa index calculus, in order to establish the diagnostic concordance between the emergency paediatrician and the paediatric dermatologist. ResultsA total of 861 patients, with a mean age of 4.5 years were included. More than half of the skin disorders analysed were eczema (27%) and infections (26%). The five main diagnoses were: atopic dermatitis (16%), acute prurigo simplex (5%), tinea (5%), pyogenic granuloma (4%), and molluscum contagiosum (4%). Additional tests were only required in 16% of the cases. The kappa index obtained was 0.206 (95% CI: 0.170–0.241). ConclusionsThe dermatology consultations in the Emergency Department were shown to be frequent and mostly involved minor diseases. Collaboration between paediatricians and dermatologists resulted in a high treatment success rate, leading to a low percentage of additional tests required and a high rate of discharges." "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Objectives" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Materials and methods" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Results" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "IntroducciónEn los últimos años, la elevada demanda de asistencia en los servicios de urgencias por enfermedad cutánea ha motivado la realización de diversos estudios al respecto. Sin embargo, la mayoría están referidos a población general, sin tener en cuenta las modificaciones en las frecuencias de las enfermedades que se producen en edad pediátrica. ObjetivosDeterminar la frecuencia de los distintos diagnósticos dermatológicos derivados por el pediatra de guardia y atendidos en la consulta de dermatología pediátrica urgente. Material y métodosEstudio retrospectivo descriptivo que incluyó todos los pacientes de 0 a 14 años atendidos tras citación por el pediatra de guardia en las consultas de dermatología infantil urgente desde junio de 2010 hasta diciembre de 2013. En segundo lugar, se realizó un estudio analítico que consistía en el cálculo del índice kappa para establecer la concordancia diagnóstica entre el diagnóstico del pediatra de Urgencias y el de Dermatología. ResultadosSe atendió a un total de 861 pacientes con una edad media de 4,5 años. Más de la mitad de toda la enfermedad atendida se debió a eccemas (27%) e infecciones (26%). Los 5 diagnósticos principales fueron: dermatitis atópica (16%), prurigo simple agudo (5%), tiña (5%), granuloma piógeno (4%) y molluscum contagiosum (4%). Solo en un 16% de los casos se solicitaron pruebas complementarias. El índice kappa obtenido fue de 0,206 (IC 95%: 0,170-0,241). ConclusionesLas consultas en urgencias pediátricas por motivos dermatológicos son frecuentes y gran parte está motivada por enfermedad banal. La colaboración entre pediatras y dermatólogos permitió una alta capacidad resolutiva, lo que se tradujo en un bajo porcentaje de pruebas complementarias solicitadas y un elevado número de altas directas." "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0030" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0035" "titulo" => "Objetivos" ] 2 => array:2 [ "identificador" => "abst0040" "titulo" => "Material y métodos" ] 3 => array:2 [ "identificador" => "abst0045" "titulo" => "Resultados" ] 4 => array:2 [ "identificador" => "abst0050" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Baquero-Sánchez E, Bernabéu-Wittel J, Dominguez-Cruz JJ, Conejo-Mir J. Urgencias dermatológicas pediátricas en un hospital de tercer nivel. An Pediatr (Barc). 2015;83:397–403." ] ] "multimedia" => array:7 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 777 "Ancho" => 1577 "Tamanyo" => 58843 ] ] "descripcion" => array:1 [ "en" => "Distribution by age." ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 942 "Ancho" => 1570 "Tamanyo" => 58150 ] ] "descripcion" => array:1 [ "en" => "Distribution of mucocutaneous infections." ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 924 "Ancho" => 1554 "Tamanyo" => 102559 ] ] "descripcion" => array:1 [ "en" => "Distribution of eczema." ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 891 "Ancho" => 1577 "Tamanyo" => 90773 ] ] "descripcion" => array:1 [ "en" => "Percentage of each supplementary test in relation to the total of tests requested." ] ] 4 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "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=""><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">By ages \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Infants: 0–1 year \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Early childhood: 1–2 years \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Preschool-aged children: 2–6 years \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">School-aged children: 6–12 years \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Children in puberty: 12–14 years \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">By diseases \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Seventeen groups of related diseases \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">A group of low-prevalence conditions \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">A group where patients with no diagnosis after being assisted was included \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Another group where patients who failed to attend their appointment was included \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab976859.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Grouping of data according to age and groups of diseases." ] ] 5 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "Data expressed as n (%)." "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 " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Group of diagnosis \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">Infants \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">Early childhood \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">Pre-schoolers \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">School-aged \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">Children in puberty \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">Total \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 " align="left" valign="top">Eczemas \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">58 (36) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">39 (31) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">72 (27) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">48 (21) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 (16) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">229 (27) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Infections \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">21 (13) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">29 (23) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">77 (29) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">79 (34) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">21 (28) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">227 (26) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Bites. Prurigo \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 (4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 (11) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">28 (10) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11 (5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 (5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">63 (7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Erythematous dermatitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 (3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17 (6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">29 (13) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 (8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">59 (7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Tumours \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 (5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 (8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11 (4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15 (6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 (12) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">53 (6) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Miscellaneous \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17 (11) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 (4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 (4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 (3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">44 (5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Failed to attend \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 (4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 (6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 (4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 (4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 (8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">41 (5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Related diseases \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 (4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 (4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 (7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">31 (4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Vascular anomalies \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19 (12) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 (2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 (0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">28 (3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Urticaria/angioedema \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 (3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 (4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 (3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 (3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25 (3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Pigmentation alterations \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 (1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Vasculitis and panniculitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 (1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Photodermatosis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 (0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 (1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Reactive dermatosis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 (3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 (0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 (1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Toxicodermy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 (0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 (1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Dermatosis caused by physical or mechanical agents \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 (0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 (0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 (1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Mouth and lips diseases \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 (0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 (0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 (0) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Genodermatosis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 (0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 (0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 (0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (0) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Unknown diagnosis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 (0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 (0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 (0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (0) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Bollous dermatosis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 (0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 (0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 (0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 (0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (0) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Total overall \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">159 (100) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">126 (100) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">268 (100) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">232 (100) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">76 (100) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">861 (100) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab976861.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Distribution of the groups of diseases according to age groups." ] ] 6 => array:7 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "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 " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Diagnosis \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 (%) \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 " align="left" valign="top">Atopic dermatitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">142 (17) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Prurigo \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">45 (5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Dermatophytosis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">39 (5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Pyogenic granuloma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">35 (4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Molluscum contagiosum \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">34 (4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Impetigo \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">33 (4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Gianotti–Crosti syndrome \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27 (3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Seborrheic dermatitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">23 (3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Scabies \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22 (3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Contact dermatitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20 (2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Bites \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18 (2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Urticaria \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18 (2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Pityriasis rosea \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18 (2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Child haemangioma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17 (2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Psoriasis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15 (2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Dyshidrotic eczema \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 (2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Herpes zoster \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13 (2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Diaper dermatitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 (1) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab976860.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Main diagnoses issued at the Emergency room in general paediatric population." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:17 [ 0 => array:3 [ "identificador" => "bib0090" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Análisis de las urgencias dermatológicas en el servicio de urgencias de un hospital comarcal" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.P. Gil Mateo" 1 => "M. Velasco Pastor" 2 => "J.B. Miquel Miquel" 3 => "E. Quecedo Estébanez" 4 => "J.A. Martínez Escribano" 5 => "E. Nagore Enguidanos" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Actas Dermosifiliogr" "fecha" => "1996" "volumen" => "87" "paginaInicial" => "305" "paginaFinal" => "309" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0095" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Urgencias dermatológicas en un hospital de referencia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "A. González Ruiz" 1 => "A.I. Bernal Ruiz" 2 => "M. García Muñoz" 3 => "A. Miranda Romero" 4 => "J. Castrodeza Sanz" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Actas Dermosifiliogr" "fecha" => "2001" "volumen" => "92" "paginaInicial" => "342" "paginaFinal" => "348" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0100" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Consultas dermatológicas en el Servicio de Urgencias: situación previa a la instauración de guardias de la especialidad" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M.L. Martínez-Martínez" 1 => "E. Escario-Travesedo" 2 => "M. Rodríguez-Vázquez" 3 => "J.M. Azaña-Defez" 4 => "M.C. Martín de Hijas-Santos" 5 => "L. Juan-Pérez-García" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ad.2010.04.011" "Revista" => array:6 [ "tituloSerie" => "Actas Dermosifiliogr" "fecha" => "2011" "volumen" => "102" "paginaInicial" => "39" "paginaFinal" => "47" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21315860" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0105" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Análisis de las urgencias dermatológicas en el Servicio de Urgencias de un hospital comarcal" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "F. Valcuende" 1 => "C. Ferraz" 2 => "G. Tomás" 3 => "A. Pitarch" 4 => "T. Almela" 5 => "F. Bertoméu" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Actas Dermosifiliogr" "fecha" => "1996" "volumen" => "76" "paginaInicial" => "676" "paginaFinal" => "680" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0110" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Urgencias dermatológicas pediátricas en un hospital terciario" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "C. Roca Saurina" 1 => "A.C. Lázaro Tremul" 2 => "A. Vicente Molinero" 3 => "A. Larumbe Irurzun" 4 => "M.P. Grasa Jordán" 5 => "F.J. Carapeto" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Piel" "fecha" => "2004" "volumen" => "19" "paginaInicial" => "124" "paginaFinal" => "130" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0115" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Urgencias dermatológicas: análisis descriptivo de 861 pacientes en un hospital terciario" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "E. Grillo" 1 => "S. Vañó-Galván" 2 => "N. Jiménez-Gómez" 3 => "A. Ballester" 4 => "E. Muñoz-Zato" 5 => "P. Jaén" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.adengl.2013.03.003" "Revista" => array:6 [ "tituloSerie" => "Actas Dermosifiliogr" "fecha" => "2013" "volumen" => "104" "paginaInicial" => "316" "paginaFinal" => "324" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23582734" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0120" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Urgencias en dermatología" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "M. Ribera" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Actas Dermosifiliogr" "fecha" => "1997" "volumen" => "88" "paginaInicial" => "353" "paginaFinal" => "357" ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0125" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Urgencias en dermatología" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "R. Suárez Fernández" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Piel" "fecha" => "2009" "volumen" => "24" "paginaInicial" => "463" "paginaFinal" => "464" ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0130" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Estudio del área de Urgencias de un hospital general. Grado de adecuación de las visitas" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M. Del Castillo" 1 => "J. Huguet" 2 => "J. Brabo" 3 => "L. Cortada" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Med Clin (Barc)" "fecha" => "1986" "volumen" => "87" "paginaInicial" => "539" "paginaFinal" => "542" ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0135" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Características de la utilización del Servicio de Urgencias en un hospital comarcal" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "A. Castillo" 1 => "N. Martínez" 2 => "L. Ferrús" 3 => "E. Portella" 4 => "J. Roma" 5 => "L. Triquell" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Gac Sanit" "fecha" => "1986" "volumen" => "5" "paginaInicial" => "190" "paginaFinal" => "193" ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0140" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Urgencias en dermatología" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J. López" 1 => "D. Argila" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Arch Dermatol (ed esp)" "fecha" => "1996" "volumen" => "7" "paginaInicial" => "54" "paginaFinal" => "64" ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0145" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Demanda pediátrica en urgencias de un hospital general" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "L. Colomés" 1 => "A. Lorenzo" 2 => "R. Ortín" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Aten Primaria" "fecha" => "1987" "volumen" => "6" "paginaInicial" => "130" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2519766" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0150" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Estudio de la demanda asistencial de un servicio de urgencias hospitalario de pediatría" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Sánchez Bayle" 1 => "E. Díaz Martínez" 2 => "J.C. Molina Cabañero" 3 => "R. Muñoz Orduña" 4 => "A. Arias Alvarez" 5 => "C. Panizo" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "An Esp Pediatr" "fecha" => "1989" "volumen" => "31" "paginaInicial" => "127" "paginaFinal" => "133" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2490315" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0155" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Estudio epidemiológico de las urgencias pediátricas en un hospital general. Factores implicados en una demanda inadecuada" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "S. Lapeña López de Armentia" 1 => "S. Reguero Celada" 2 => "M. García Rabanal" 3 => "M. Gutiérrez Fernández" 4 => "I. Abdallah" 5 => "H. González Aparicio" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "An Esp Pediatr" "fecha" => "1996" "volumen" => "44" "paginaInicial" => "121" "paginaFinal" => "125" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8830569" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0160" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Demanda inadecuada en un servicio de urgencias pediátrico hospitalario: factores implicados" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M.D. Antón" 1 => "J.C. Peña" 2 => "R. Santos" 3 => "E. Sempere" 4 => "J. Martínez" 5 => "L.A. Pérula" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Med Clin (Barc)" "fecha" => "1992" "volumen" => "99" "paginaInicial" => "743" "paginaFinal" => "746" ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0165" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Estudio de concordancia diagnóstica en Dermatología entre Atención Primaria y Especializada en el área de salud de un hospital de referencia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "N. Porta" 1 => "J. San Juan" 2 => "M.P. Grasc" 3 => "E. Simal" 4 => "M. Ara" 5 => "I. Querol" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Actas Dermosifiliogr" "fecha" => "2008" "volumen" => "99" "paginaInicial" => "207" "paginaFinal" => "212" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18358196" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0170" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diagnosis of skin disease by nondermatologists" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A.B. Fleischer Jr." 1 => "C.R. Herbert" 2 => "S. Feldman" 3 => "F. O’Brien" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Am J Manag Care" "fecha" => "2000" "volumen" => "6" "paginaInicial" => "1149" "paginaFinal" => "1156" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11184670" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23412879/0000008300000006/v2_201601190027/S2341287915001714/v2_201601190027/en/main.assets" "Apartado" => array:4 [ "identificador" => "26005" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original Articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23412879/0000008300000006/v2_201601190027/S2341287915001714/v2_201601190027/en/main.pdf?idApp=UINPBA00005H&text.app=https://analesdepediatria.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287915001714?idApp=UINPBA00005H"]

Statistics

Original Article

Paediatric dermatology emergencies in a tertiary hospital

Urgencias dermatológicas pediátricas en un hospital de tercer nivel

E. Baquero-Sánchez

Corresponding author

elena_baquero@hotmail.com

Corresponding author.

, J. Bernabéu-Wittel, J.J. Dominguez-Cruz, J. Conejo-Mir

Servicio de Dermatología, Hospital Universitario Virgen del Rocío, Sevilla, Spain

Read

6775

Times
was read the article

2380

Total PDF

4395

Total HTML

Share statistics

 array:24 [
  "pii" => "S2341287915001714"
  "issn" => "23412879"
  "doi" => "10.1016/j.anpede.2015.09.008"
  "estado" => "S300"
  "fechaPublicacion" => "2015-12-01"
  "aid" => "1803"
  "copyright" => "Asociaci&#243;n Espa&#241;ola de Pediatr&#237;a"
  "copyrightAnyo" => "2014"
  "documento" => "article"
  "crossmark" => 1
  "subdocumento" => "fla"
  "cita" => "An Pediatr &#40;Barc&#41;. 2015;83:397-403"
  "abierto" => array:3 [
    "ES" => false
    "ES2" => false
    "LATM" => false
  ]
  "gratuito" => false
  "lecturas" => array:2 [
    "total" => 2157
    "formatos" => array:3 [
      "EPUB" => 152
      "HTML" => 1531
      "PDF" => 474
    ]
  ]
  "Traduccion" => array:1 [
    "es" => array:19 [
      "pii" => "S1695403315000375"
      "issn" => "16954033"
      "doi" => "10.1016/j.anpedi.2015.01.001"
      "estado" => "S300"
      "fechaPublicacion" => "2015-12-01"
      "aid" => "1803"
      "copyright" => "Asociaci&#243;n Espa&#241;ola de Pediatr&#237;a"
      "documento" => "article"
      "crossmark" => 1
      "subdocumento" => "fla"
      "cita" => "An Pediatr &#40;Barc&#41;. 2015;83:397-403"
      "abierto" => array:3 [
        "ES" => false
        "ES2" => false
        "LATM" => false
      ]
      "gratuito" => false
      "lecturas" => array:2 [
        "total" => 5520
        "formatos" => array:3 [
          "EPUB" => 124
          "HTML" => 3514
          "PDF" => 1882
        ]
      ]
      "es" => array:13 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">ORIGINAL</span>"
        "titulo" => "Urgencias dermatol&#243;gicas pedi&#225;tricas en un hospital de tercer nivel"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "tieneResumen" => array:2 [
          0 => "es"
          1 => "en"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "397"
            "paginaFinal" => "403"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Paediatric dermatology emergencies in a tertiary hospital"
          ]
        ]
        "contieneResumen" => array:2 [
          "es" => true
          "en" => true
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 0
          "multimedia" => array:7 [
            "identificador" => "fig0005"
            "etiqueta" => "Figura 1"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "gr1.jpeg"
                "Alto" => 777
                "Ancho" => 1577
                "Tamanyo" => 59228
              ]
            ]
            "descripcion" => array:1 [
              "es" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Distribuci&#243;n por edad&#46;</p>"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "E&#46; Baquero-S&#225;nchez, J&#46; Bernab&#233;u-Wittel, J&#46;J&#46; Dominguez-Cruz, J&#46; Conejo-Mir"
            "autores" => array:4 [
              0 => array:2 [
                "nombre" => "E&#46;"
                "apellidos" => "Baquero-S&#225;nchez"
              ]
              1 => array:2 [
                "nombre" => "J&#46;"
                "apellidos" => "Bernab&#233;u-Wittel"
              ]
              2 => array:2 [
                "nombre" => "J&#46;J&#46;"
                "apellidos" => "Dominguez-Cruz"
              ]
              3 => array:2 [
                "nombre" => "J&#46;"
                "apellidos" => "Conejo-Mir"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S2341287915001714"
          "doi" => "10.1016/j.anpede.2015.09.008"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => false
            "ES2" => false
            "LATM" => false
          ]
          "gratuito" => false
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287915001714?idApp=UINPBA00005H"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1695403315000375?idApp=UINPBA00005H"
      "url" => "/16954033/0000008300000006/v1_201512060011/S1695403315000375/v1_201512060011/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S2341287915001866"
    "issn" => "23412879"
    "doi" => "10.1016/j.anpede.2015.09.015"
    "estado" => "S300"
    "fechaPublicacion" => "2015-12-01"
    "aid" => "1804"
    "copyright" => "Asociaci&#243;n Espa&#241;ola de Pediatr&#237;a"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "fla"
    "cita" => "An Pediatr &#40;Barc&#41;. 2015;83:404-9"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 1825
      "formatos" => array:3 [
        "EPUB" => 129
        "HTML" => 1212
        "PDF" => 484
      ]
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>"
      "titulo" => "Long-term outcomes of children treated with continuous renal replacement therapy"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "404"
          "paginaFinal" => "409"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Evoluci&#243;n a largo plazo de los ni&#241;os tratados con t&#233;cnicas de depuraci&#243;n extrarrenal continua"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0010"
          "etiqueta" => "Figure 2"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr2.jpeg"
              "Alto" => 973
              "Ancho" => 1572
              "Tamanyo" => 68452
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Creatinine progress &#40;median and interquartile range&#41; throughout evolution&#46; CRRT&#58; continuous extrarenal depuration technique&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "S&#46; Almarza, K&#46; Bialobrzeska, M&#46;M&#46; Casellas, M&#46;J&#46; Santiago, J&#46; L&#243;pez-Herce, B&#46; Toledo, &#193;&#46; Carrillo"
          "autores" => array:7 [
            0 => array:2 [
              "nombre" => "S&#46;"
              "apellidos" => "Almarza"
            ]
            1 => array:2 [
              "nombre" => "K&#46;"
              "apellidos" => "Bialobrzeska"
            ]
            2 => array:2 [
              "nombre" => "M&#46;M&#46;"
              "apellidos" => "Casellas"
            ]
            3 => array:2 [
              "nombre" => "M&#46;J&#46;"
              "apellidos" => "Santiago"
            ]
            4 => array:2 [
              "nombre" => "J&#46;"
              "apellidos" => "L&#243;pez-Herce"
            ]
            5 => array:2 [
              "nombre" => "B&#46;"
              "apellidos" => "Toledo"
            ]
            6 => array:2 [
              "nombre" => "&#193;&#46;"
              "apellidos" => "Carrillo"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S1695403315000387"
        "doi" => "10.1016/j.anpedi.2014.12.018"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => false
          "ES2" => false
          "LATM" => false
        ]
        "gratuito" => false
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1695403315000387?idApp=UINPBA00005H"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287915001866?idApp=UINPBA00005H"
    "url" => "/23412879/0000008300000006/v2_201601190027/S2341287915001866/v2_201601190027/en/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S2341287915001908"
    "issn" => "23412879"
    "doi" => "10.1016/j.anpede.2015.09.018"
    "estado" => "S300"
    "fechaPublicacion" => "2015-12-01"
    "aid" => "1809"
    "copyright" => "Asociaci&#243;n Espa&#241;ola de Pediatr&#237;a"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "fla"
    "cita" => "An Pediatr &#40;Barc&#41;. 2015;83:387-96"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 2808
      "formatos" => array:3 [
        "EPUB" => 150
        "HTML" => 2025
        "PDF" => 633
      ]
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>"
      "titulo" => "Development and validation of a Breastfeeding Knowledge and Skills Questionnaire"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "387"
          "paginaFinal" => "396"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Validaci&#243;n de un cuestionario sobre conocimientos y habilidades en lactancia materna"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Figure 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 1437
              "Ancho" => 1582
              "Tamanyo" => 75081
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Group scoring&#46; Box and whisker plot&#46; For each group&#44; a box represents the interquartile range &#40;IQR&#41;&#44; the centre line represents the median&#44; and the notches the 95&#37; confidence interval of the median&#46; The upper and lower whiskers reach respectively the maximum or minimum value at a distance of 1&#46;5&#42;IQR from the box&#46; Extreme values are represented individually&#46; The thick horizontal line at 70&#37; represents <span class="elsevierStyleItalic">sufficient</span>&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "M&#46; G&#243;mez Fern&#225;ndez-Vegue, M&#46; Men&#233;ndez Orenga"
          "autores" => array:2 [
            0 => array:2 [
              "nombre" => "M&#46;"
              "apellidos" => "G&#243;mez Fern&#225;ndez-Vegue"
            ]
            1 => array:2 [
              "nombre" => "M&#46;"
              "apellidos" => "Men&#233;ndez Orenga"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S1695403315000442"
        "doi" => "10.1016/j.anpedi.2015.01.006"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => false
          "ES2" => false
          "LATM" => false
        ]
        "gratuito" => false
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1695403315000442?idApp=UINPBA00005H"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287915001908?idApp=UINPBA00005H"
    "url" => "/23412879/0000008300000006/v2_201601190027/S2341287915001908/v2_201601190027/en/main.assets"
  ]
  "en" => array:20 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>"
    "titulo" => "Paediatric dermatology emergencies in a tertiary hospital"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "397"
        "paginaFinal" => "403"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "E&#46; Baquero-S&#225;nchez, J&#46; Bernab&#233;u-Wittel, J&#46;J&#46; Dominguez-Cruz, J&#46; Conejo-Mir"
        "autores" => array:4 [
          0 => array:4 [
            "nombre" => "E&#46;"
            "apellidos" => "Baquero-S&#225;nchez"
            "email" => array:1 [
              0 => "elena&#95;baquero&#64;hotmail&#46;com"
            ]
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:2 [
            "nombre" => "J&#46;"
            "apellidos" => "Bernab&#233;u-Wittel"
          ]
          2 => array:2 [
            "nombre" => "J&#46;J&#46;"
            "apellidos" => "Dominguez-Cruz"
          ]
          3 => array:2 [
            "nombre" => "J&#46;"
            "apellidos" => "Conejo-Mir"
          ]
        ]
        "afiliaciones" => array:1 [
          0 => array:2 [
            "entidad" => "Servicio de Dermatolog&#237;a&#44; Hospital Universitario Virgen del Roc&#237;o&#44; Sevilla&#44; Spain"
            "identificador" => "aff0005"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Urgencias dermatol&#243;gicas pedi&#225;tricas en un hospital de tercer nivel"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 942
            "Ancho" => 1570
            "Tamanyo" => 58150
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Distribution of mucocutaneous infections&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">In the last years&#44; several studies have been published on dermatological emergencies in our area&#44; all except one concerning the general population&#46;<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">1&#8211;8</span></a> The increasing interest in this issue is mainly derived from the progressive increase in the demand for assistance in hospital emergency services&#44; up to the point that an annual increase of 10&#8211;20&#37; is calculated for emergency assistance&#46;<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">9&#44;10</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">This growth is mainly due to minor diseases&#46; At the same time&#44; emergency dermatological cases have not been the exception to that increasing trend&#46; It is estimated that the emergency dermatological demand represents 8&#8211;10&#37; of the total emergency cases at a general hospital&#44; and up to 10&#46;2&#37; in the paediatric population&#46;<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">11&#44;12</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The main factors involved in this improper use of hospital emergencies are the lack of trust in primary care&#44; lack of health education and waiting lists&#44;<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">9&#44;13&#8211;15</span></a> with the added aspect in dermatology of the spectacular nature of skin signs and symptoms&#44; which create huge anxiety in the patient or&#44; more frequently during the paediatric age&#44; their relatives&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The main goal of the study was to describe the profile of the user and determine the frequency of the various dermatological diagnoses referred by the paediatrician on duty and attended to the emergency paediatric dermatological office&#44; since most prior studies refer to the general population<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">1&#8211;8</span></a> and it is not possible to extrapolate the results to this subgroup&#44; where we know there are changes in the frequencies of diagnoses&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">5</span></a> As a secondary goal&#44; we aimed to analyse the resolution capacity of the dermatologist on duty&#44; as well as the profitability of emergency paediatric dermatological consultation&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Materials and methods</span><p id="par0025" class="elsevierStylePara elsevierViewall">The study was carried out in a third-level hospital with 100 beds&#44; 115 of those in the Children&#39;s Hospital&#44; covering an area of 554&#44;981 inhabitants&#44; 16&#37; of whom are the paediatric population&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">This hospital has a dermatology resident on duty Mondays to Fridays to cover general dermatological emergencies&#44; 3&#8211;8<span class="elsevierStyleHsp" style=""></span>pm&#44; and 2 days of the week&#44; Mondays and Thursdays&#44; with the help of a second resident &#40;third or fourth year&#41; for assistance at the dermatological emergency office&#44; also 3&#8211;8<span class="elsevierStyleHsp" style=""></span>pm&#46; In this way&#44; all patients 0&#8211;14 years old attending the Casualty Department for dermatological reasons are previously examined by the paediatrician on duty or paediatrics resident&#44; who may&#44; if necessary&#44; call the dermatologist for urgent cases&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">A retrospective study was designed based on the data collected from clinical records of all patients attending paediatric dermatological emergencies from June 2010 to December 2013&#44; a total of 861 patients&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Emergency attendance sheets were reviewed as part of the work protocol when the patient is discharged and referred to dermatological emergencies&#44; and the subsequent medical history at that consultation&#46; The following data were gathered for each patient&#58; name and surname&#44; age&#44; gender&#44; date of attendance&#44; supplementary evidence requested&#44; destination upon discharge and diagnosis&#44; both that of the paediatrician in the discharge report and the subsequent diagnosis by the Dermatology resident&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">To facilitate the development of the study&#44; the data were collected as stated in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">First&#44; a descriptive study of the observed characteristics of patients was carried out&#46; For qualitative variables&#44; the absolute frequency of each category and percentages were used&#59; for quantitative variables&#44; the mean&#44; median&#44; standard deviation and range were used&#46; In contrast&#44; if the quantitative variables followed a normal distribution&#44; the Kolmogorov&#8211;Smirnov test was used&#46; Secondly&#44; an analytical study was carried out by preparing contingency tables and calculating the kappa index&#44; to establish the diagnosis concordance between the diagnosis upon discharge previously issued at the General Paediatric Emergency Department and the dermatology diagnosis&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">The statistical analysis was carried out using version 18&#46;0 of the statistical software <span class="elsevierStyleItalic">Statistical Package for the Social Sciences</span> &#40;SPSS Inc&#46;&#44; Chicago&#44; IL&#44; USA&#41;&#46; All confidence intervals calculated were at 95&#37;&#44; and all <span class="elsevierStyleItalic">p</span> values were calculated bilaterally&#44; considering values below 0&#46;05 as statistically significant&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Results</span><p id="par0060" class="elsevierStylePara elsevierViewall">During the period of the study&#44; 861 patients were called to consultation&#44; after excluding revisits &#40;patients who attended again for the same reason they had been assessed for at the Casualty Department and the consultation at the Dermatological Emergency Department&#41;&#46; A mean of 20 patients a month were attended to&#44; observing a higher attendance volume during October &#40;24&#46;3 patients&#47;month&#41;&#44; April &#40;24 patients&#47;month&#41; and May &#40;24 patients&#47;month&#41;&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Of the 861 patients attended to&#44; 466 &#40;54&#37;&#41; were boys and 395 &#40;46&#37;&#41; girls &#40;there are no statistically significant differences&#41;&#46; The mean age was 4&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4 years&#44; the median&#44; 3 years&#44; and the mode&#44; 0 years &#40;from birth to 11 months&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Regarding the distribution by age groups&#44; the population with the highest demand were pre-schoolers &#40;31&#37;&#41;&#44; followed by school-aged children &#40;27&#37;&#41;&#44; infants &#40;18&#37;&#41;&#44; early childhood &#40;15&#37;&#41; and lastly children in puberty &#40;9&#37;&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">By diagnosis groups &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#44; eczema &#40;27&#37;&#41; and infections &#40;26&#37;&#41; were the main reasons for consultation&#44; together representing more than half the consultations&#46; Following those in terms of frequency&#44; erythematous dermatitis &#40;7&#37;&#41;&#44; bites&#47;prurigo simplex &#40;7&#37;&#41;&#44; tumours &#40;6&#37;&#41; and the miscellaneous group &#40;5&#37;&#41;&#46; This last group included various diagnoses related to the paediatric age&#44; such as mastocytosis&#44; histiocytosis&#44; enteropathic acrodermatitis and toxic erythema in the new-born&#46; Forty-one patients &#40;5&#37;&#41; did not attend their appointments at the Emergency Paediatric Dermatology Department and for three patients no diagnosis was issued after attendance&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">Within the infections group&#44; 111 &#40;50&#37;&#41; were of viral origin&#44; 50 &#40;22&#37;&#41; of fungal origin&#44; 40 &#40;18&#37;&#41; of bacterial origin&#44; and&#44; lastly&#44; 22 &#40;10&#37;&#41; of parasitic origin &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#44; while in the eczema group&#44; 141 &#40;62&#37;&#41; were due to atopic dermatitis&#44; followed in frequency by seborrheic dermatitis in 23 patients &#40;10&#37;&#41; and contact dermatitis in 20 &#40;9&#37;&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">As reflected in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#44; these groups of diseases were also analysed based on the age groups&#44; showing differences in the frequencies of the diseases within the different groups&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Regarding the diagnosis made&#44; 66&#37; of consultations were for 18 diseases &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46; However&#44; a total of 108 different diagnoses were issued&#46; Out of those&#44; the main individual processes were&#58; atopic dermatitis &#40;16&#37;&#41;&#44; acute prurigo simplex &#40;5&#37;&#41;&#44; dermatophytosis &#40;5&#37;&#41;&#44; pyogenic granuloma &#40;4&#37;&#41;&#44; <span class="elsevierStyleItalic">molluscum contagious</span> &#40;4&#37;&#41; and impetigo &#40;4&#37;&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">Regarding the consumption of supplementary tests&#44; these were only required for 166 patients &#40;16&#37;&#41;&#59; the one requested most frequently was microbiological culture &#40;35&#37;&#41;&#44; followed by blood test with haemogram and biochemical &#40;22&#37;&#41;&#44; serology &#40;10&#37;&#41;&#44; skin biopsy &#40;10&#37;&#41;&#44; CRP for herpesviridae &#40;8&#37;&#41;&#44; immunology study &#40;5&#37;&#41; and imaging tests &#40;4&#37;&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>&#41;&#46; In the group called &#8220;Others&#8221;&#44; electrocardiograms and specific analytical determinations were included&#44; such as cinquemia&#44; serum triptase&#44; etc&#46;</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">Regarding destination after attendance&#44; 48&#37; of patients were directly discharged without the need for further consultations&#59; 43&#37; were referred to consultation to the ordinary Paediatric Dermatology Department&#59; 6&#37; of patients were referred by their GP and a later assessment by their dermatologist&#46; In &#8220;other destinations&#8221; &#40;2&#37;&#41;&#44; referrals to other consultants and their hospitals of reference were included&#46; The resulting admission rate was 1&#37; and included five children admitted with the following diagnoses&#58; two due to infant haemorrhagic oedema&#44; two due to eczema herpeticum and one due to disseminated herpes zoster in an immunocompromised patient&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">When analysing all Casualty Department discharge reports of patients who were afterwards transferred to the Emergency Dermatology Department&#44; it was observed that in 67&#37; of the discharge there was a specific clinical judgement by the paediatrician&#44; in 20&#37; a descriptive diagnosis based on element lesions&#44; and in 13&#37; of the reports there was no dermatology diagnosis&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">For the purposes of establishing diagnosis concordance among those cases where a specific clinical judgement was reached in the Casualty Department and afterwards assessment in the consultation by the Emergency Paediatric Dermatology Department&#44; a contingency table was prepared whereby a kappa index of 0&#46;206 was obtained &#40;95&#37; CI&#58; 0&#46;170&#8211;0&#46;241&#41;&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Discussion</span><p id="par0110" class="elsevierStylePara elsevierViewall">Although dermatology has been considered as a specialisation with no emergency service&#44; it cannot be denied that the number of patients requesting immediate care in the Emergency Departments due to dermatological reasons represents a significant percentage of the total&#44; with an estimated 8&#8211;10&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">11&#44;12</span></a> As expected&#44; most of these consultations are not for truly serious diseases or diseases which may put the patient&#39;s life at risk&#46;<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">1&#8211;8</span></a> However&#44; this increase in the demand for care in hospital Emergency Departments mainly due to minor complaints is not exclusive to dermatology&#44; since it has been estimated that between one and two-thirds of the total consultations in Paediatric Emergency Departments are due to minor diseases&#46;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">14&#44;15</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">However&#44; whether or not skin diseases are serious&#44; there are other determinants leading the patient &#40;or the relative&#44; in this case&#41; to attend the Casualty Department&#44; such as the spectacular nature of the signs and symptoms &#40;especially pruritus&#41;&#44; the lack of information&#44; doubts on whether the condition is transmissible&#44; etc&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Due to the differences among health systems of each country&#44; our discussion is based on prior studies carried out in Spain&#39;s public health system&#46;<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">1&#8211;8</span></a> Thus&#44; the mean age obtained in our study &#40;4&#46;5 years&#41; was lower than that found in the study carried out by Roca Saurina et al&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">5</span></a> and that stated by Colom&#233;s et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">12</span></a> who refer the highest volume of attendance in ages 6 and 7&#46; In fact&#44; the patients with most consultations in our case were 0 to 1 year&#46; Although the age groups created are heterogeneous as regard the period included &#40;for instance&#44; the group of infants includes from 0 to one year and the group of school-aged children 6&#8211;12 years&#41;&#44; we think the information on the distribution of patients in the different stages is of interest&#44; taking into consideration the large clinical and physiological variability in these relatively short periods of time &#40;differences are evident between&#44; for instance&#44; an infant and a school-aged child&#41;&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">As regards gender&#44; studies on the general population have reported female predominance&#59;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">6</span></a> however&#44; in our study&#44; as in the study by Roca Saurina et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">5</span></a> no significant gender differences were shown&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">When analysing the main diagnosis groups and comparing them with those obtained by other authors&#44; we noted that infections were the main diagnosis groups in all studies&#44; followed by eczema&#47;dermatitis&#46;<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">1&#8211;8</span></a> In our case&#44; the frequency of both groups was very similar&#44; which we think is because in our study the mean age was lower and we attended to a larger number of infants&#44; who often attend due to atopic dermatitis and other eczema&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">The group of bites&#47;prurigo was third in terms of frequency in children&#44; as already described&#44;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">5</span></a> while in the general population this position was occupied by the group of urticaria&#47;angioedema&#46;<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">1&#8211;4&#44;6</span></a></p><p id="par0140" class="elsevierStylePara elsevierViewall">Regarding infections&#44; the ones with the highest prevalence were those of viral origin &#40;50&#37; overall&#41;&#44; matching the data obtained by Roca Saurina et al&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">5</span></a>&#59; but different from the data obtained in adults&#44; where there is a predominance of bacterial origin&#46;<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">1&#8211;4&#44;6</span></a> However&#44; in our work fungal infections were second in terms of frequency &#40;22&#37;&#41;&#44; followed by bacterial infections &#40;18&#37;&#41;&#44; while in the work by Roca Saurina et al&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">5</span></a> bacterial infections were second in terms of frequency&#44; followed by fungal infections&#46; This difference may be due to the fact that in our case the dermatologist does not attend the Emergency room daily&#44; and the patient has to be called to attend&#44; and the paediatrician attends to the dermatological disease more frequently&#46; In the case of eczema&#44; both in our study and that carried out by Roca Saurina et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">5</span></a> the most frequent cause is atopic dermatitis&#44; while in adults it is contact dermatitis&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">6</span></a></p><p id="par0145" class="elsevierStylePara elsevierViewall">As regards the distribution of diagnosis groups&#44; it is noteworthy how the frequencies of the diseases are modified in the different intervals&#44; in such a way that the group of infants was the one most different from the general population&#46; As the age of the patient increased&#44; the diagnoses were more and more similar to those of the general population&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">5</span></a> In fact&#44; in the infants group&#44; the percentage of eczema was much higher than in the other groups &#40;36&#37; overall in relation to 16&#37; in children in puberty&#41;&#44; mainly due to the higher frequency of atopic dermatitis in that population&#46; It is noteworthy that 12&#37; of the consultations in infants were due to vascular anomalies&#46; In our study&#44; unlike the earlier ones&#44; we decided to differentiate this group&#44; where vascular malformations and vascular tumours are included&#44; mainly child haemangiomas and their complications&#44; in the group of tumours because there are differences in management in relation to other tumours and because the centre has a specific Child Vascular Anomalies unit&#46; The miscellaneous group was third in terms of frequency in this group&#44; and included diseases typical of paediatric age&#44; as already mentioned&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">In early childhood &#40;1&#8211;2 years&#41; there is still a predominance&#44; although less pronounced&#44; of eczema &#40;31&#37; overall&#41;&#44; and consultations due to infections almost doubled &#40;23&#37;&#41;&#46; There was also a significant increase in this group of consultations due to bites and prurigo &#40;11&#37;&#41;&#44; and a 2&#37; drop in consultations due to vascular anomalies&#44; as expected&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">In pre-schoolers and school-aged children&#44; infections and eczema continued to be the main causes of demand for care&#44; but infections become more frequent than eczema&#46; This inversion is due to the fact that&#44; on the one hand&#44; there was a decrease in some types of eczema&#44; such as seborrheic dermatitis and atopic dermatitis&#44; and&#44; on the other&#44; the increase in infections&#44; mainly those of viral origin&#46; In addition&#44; the increase of consultations for other causes&#44; such as erythematous dermatitis&#44; with frequencies four times above those observed in the prior groups&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Lastly&#44; in children in puberty infections continue to have predominance over eczema&#44; but the frequency in both groups decreased and other groups become relevant&#44; such as the tumours group &#40;8&#37; overall&#41;&#44; with a large part of these consultations caused by pyogenic granulomas which may cause significant clinical symptoms&#44; such as bleeding and rapid growth&#46; It is worth noting the relevant difference obtained when comparing the frequencies of the urticaria and angioedema categories in the group of children in puberty according to the data published by Roca Saurina et al&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">5</span></a> and ours&#46; In their case&#44; urticaria&#47;angioedema represented 30&#37; of emergency consultations in this age group&#44; while in our case it was 3&#37;&#46; We again attribute this marked difference to the system for calling patients to attend and the role of the paediatrician as a filter&#44; who&#44; except in atypical or torpid progression cases&#44; usually has no trouble with the diagnosis and initial management of this disease&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">As regards the resolution capacity of the dermatologist on duty&#44; we noted how in our study the consumption of supplementary tests was low&#44; data similar to those found by Grillo et al&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">6</span></a> Also&#44; the most requested test was microbiological culture&#44; a test that is easy to carry out&#44; affordable and not at all aggressive&#46; The percentage of skin biopsies was far below those carried out in adults&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">6</span></a> Almost half of the patients were directly discharged without the need for supplementary tests&#46; Most cases transferred to child dermatology were carried out with a diagnosis and a treatment line already started&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">The global concordance between the diagnoses issued by the family doctor and the dermatologist is&#44; according to some studies&#44; 40&#8211;60&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">16&#44;17</span></a> In our study the concordance percentage was 57&#37; and the kappa index 0&#46;206 &#40;95&#37; CI&#58; 0&#46;170&#8211;0&#46;241&#41;&#44; reflecting a scarce correlation&#46; The interpretation of these data has a series of limitations&#44; such as that only cases where both the paediatrician and the dermatologist have issued a diagnosis can be included&#44; and that we only included cases attended to in the Emergency Paediatric Dermatology Department and who&#44; therefore&#44; have posed a question or enquiry to the paediatrician&#44; and not all those who were actually assessed in the Casualty Department&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conclusions</span><p id="par0175" class="elsevierStylePara elsevierViewall">It has been widely proven that pathological dermatology processes cause a large health care demand in Emergency Departments globally&#44; and especially high during the paediatric age&#46; Although most consultations were not due to serious diseases&#44; these were perceived by parents as alarming&#44; and there is a small percentage of diseases which do pose a real danger for the life of the child in the short term&#44; such as eczema herpeticum or vasculitis&#44; where the dermatologist on duty plays an important role both in the diagnosis and management&#46; On the other hand&#44; the dermatologist on duty offers a high resolution capacity regarding the low percentage of supplementary tests requested and the number of direct discharges&#46; Lastly&#44; carrying out epidemiology studies like the one presented would provide a better understanding of the clinical dermatological reality we attend to&#44; and would allow us to prepare training plans for residents and paediatricians for the purpose of improving health care quality&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conflict of interests</span><p id="par0180" class="elsevierStylePara elsevierViewall">The authors declare that there are no conflicts of interest&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:11 [
        0 => array:3 [
          "identificador" => "xres597267"
          "titulo" => "Abstract"
          "secciones" => array:5 [
            0 => array:2 [
              "identificador" => "abst0005"
              "titulo" => "Introduction"
            ]
            1 => array:2 [
              "identificador" => "abst0010"
              "titulo" => "Objectives"
            ]
            2 => array:2 [
              "identificador" => "abst0015"
              "titulo" => "Materials and methods"
            ]
            3 => array:2 [
              "identificador" => "abst0020"
              "titulo" => "Results"
            ]
            4 => array:2 [
              "identificador" => "abst0025"
              "titulo" => "Conclusions"
            ]
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec611983"
          "titulo" => "Keywords"
        ]
        2 => array:3 [
          "identificador" => "xres597268"
          "titulo" => "Resumen"
          "secciones" => array:5 [
            0 => array:2 [
              "identificador" => "abst0030"
              "titulo" => "Introducci&#243;n"
            ]
            1 => array:2 [
              "identificador" => "abst0035"
              "titulo" => "Objetivos"
            ]
            2 => array:2 [
              "identificador" => "abst0040"
              "titulo" => "Material y m&#233;todos"
            ]
            3 => array:2 [
              "identificador" => "abst0045"
              "titulo" => "Resultados"
            ]
            4 => array:2 [
              "identificador" => "abst0050"
              "titulo" => "Conclusiones"
            ]
          ]
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec611982"
          "titulo" => "Palabras clave"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        5 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Materials and methods"
        ]
        6 => array:2 [
          "identificador" => "sec0015"
          "titulo" => "Results"
        ]
        7 => array:2 [
          "identificador" => "sec0020"
          "titulo" => "Discussion"
        ]
        8 => array:2 [
          "identificador" => "sec0025"
          "titulo" => "Conclusions"
        ]
        9 => array:2 [
          "identificador" => "sec0030"
          "titulo" => "Conflict of interests"
        ]
        10 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2014-10-02"
    "fechaAceptado" => "2015-01-09"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec611983"
          "palabras" => array:3 [
            0 => "Emergencies"
            1 => "Paediatric dermatology"
            2 => "Epidemiology"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec611982"
          "palabras" => array:3 [
            0 => "Urgencias"
            1 => "Dermatolog&#237;a pedi&#225;trica"
            2 => "Epidemiolog&#237;a"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">In recent years&#44; the increasing demand for dermatological consultations in the Emergency Department has resulted in the publication of a variety of studies on this subject&#46; However&#44; most of them deal with the general population&#44; without taking into account the changes in frequencies found in young children &#40;ages 0&#8211;14&#41;&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objectives</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">To determine the frequency of various dermatological diagnoses made by the on-call paediatrician in the Emergency Department&#44; and after referral to paediatric dermatology&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Materials and methods</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Firstly&#44; a descriptive retrospective study was performed that included all patients aged between 0 and 14 years old who were seen after being referred to the emergency paediatric dermatologist by the on-call paediatrician from June 2010 to December 2013&#46; Secondly&#44; an analytical study was carried out by calculating the kappa index calculus&#44; in order to establish the diagnostic concordance between the emergency paediatrician and the paediatric dermatologist&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">A total of 861 patients&#44; with a mean age of 4&#46;5 years were included&#46; More than half of the skin disorders analysed were eczema &#40;27&#37;&#41; and infections &#40;26&#37;&#41;&#46; The five main diagnoses were&#58; atopic dermatitis &#40;16&#37;&#41;&#44; acute prurigo simplex &#40;5&#37;&#41;&#44; tinea &#40;5&#37;&#41;&#44; pyogenic granuloma &#40;4&#37;&#41;&#44; and <span class="elsevierStyleItalic">molluscum contagiosum</span> &#40;4&#37;&#41;&#46; Additional tests were only required in 16&#37; of the cases&#46; The kappa index obtained was 0&#46;206 &#40;95&#37; <span class="elsevierStyleSmallCaps">CI</span>&#58; 0&#46;170&#8211;0&#46;241&#41;&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusions</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">The dermatology consultations in the Emergency Department were shown to be frequent and mostly involved minor diseases&#46; Collaboration between paediatricians and dermatologists resulted in a high treatment success rate&#44; leading to a low percentage of additional tests required and a high rate of discharges&#46;</p></span>"
        "secciones" => array:5 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Introduction"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Objectives"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Materials and methods"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Results"
          ]
          4 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Conclusions"
          ]
        ]
      ]
      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Introducci&#243;n</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">En los &#250;ltimos a&#241;os&#44; la elevada demanda de asistencia en los servicios de urgencias por enfermedad cut&#225;nea ha motivado la realizaci&#243;n de diversos estudios al respecto&#46; Sin embargo&#44; la mayor&#237;a est&#225;n referidos a poblaci&#243;n general&#44; sin tener en cuenta las modificaciones en las frecuencias de las enfermedades que se producen en edad pedi&#225;trica&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Objetivos</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Determinar la frecuencia de los distintos diagn&#243;sticos dermatol&#243;gicos derivados por el pediatra de guardia y atendidos en la consulta de dermatolog&#237;a pedi&#225;trica urgente&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Material y m&#233;todos</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Estudio retrospectivo descriptivo que incluy&#243; todos los pacientes de 0 a 14 a&#241;os atendidos tras citaci&#243;n por el pediatra de guardia en las consultas de dermatolog&#237;a infantil urgente desde junio de 2010 hasta diciembre de 2013&#46; En segundo lugar&#44; se realiz&#243; un estudio anal&#237;tico que consist&#237;a en el c&#225;lculo del &#237;ndice kappa para establecer la concordancia diagn&#243;stica entre el diagn&#243;stico del pediatra de Urgencias y el de Dermatolog&#237;a&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Se atendi&#243; a un total de 861 pacientes con una edad media de 4&#44;5 a&#241;os&#46; M&#225;s de la mitad de toda la enfermedad atendida se debi&#243; a eccemas &#40;27&#37;&#41; e infecciones &#40;26&#37;&#41;&#46; Los 5 diagn&#243;sticos principales fueron&#58; dermatitis at&#243;pica &#40;16&#37;&#41;&#44; prurigo simple agudo &#40;5&#37;&#41;&#44; ti&#241;a &#40;5&#37;&#41;&#44; granuloma pi&#243;geno &#40;4&#37;&#41; y <span class="elsevierStyleItalic">molluscum contagiosum</span> &#40;4&#37;&#41;&#46; Solo en un 16&#37; de los casos se solicitaron pruebas complementarias&#46; El &#237;ndice kappa obtenido fue de 0&#44;206 &#40;IC 95&#37;&#58; 0&#44;170-0&#44;241&#41;&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conclusiones</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Las consultas en urgencias pedi&#225;tricas por motivos dermatol&#243;gicos son frecuentes y gran parte est&#225; motivada por enfermedad banal&#46; La colaboraci&#243;n entre pediatras y dermat&#243;logos permiti&#243; una alta capacidad resolutiva&#44; lo que se tradujo en un bajo porcentaje de pruebas complementarias solicitadas y un elevado n&#250;mero de altas directas&#46;</p></span>"
        "secciones" => array:5 [
          0 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Introducci&#243;n"
          ]
          1 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Objetivos"
          ]
          2 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Material y m&#233;todos"
          ]
          3 => array:2 [
            "identificador" => "abst0045"
            "titulo" => "Resultados"
          ]
          4 => array:2 [
            "identificador" => "abst0050"
            "titulo" => "Conclusiones"
          ]
        ]
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Baquero-S&#225;nchez E&#44; Bernab&#233;u-Wittel J&#44; Dominguez-Cruz JJ&#44; Conejo-Mir J&#46; Urgencias dermatol&#243;gicas pedi&#225;tricas en un hospital de tercer nivel&#46; An Pediatr &#40;Barc&#41;&#46; 2015&#59;83&#58;397&#8211;403&#46;</p>"
      ]
    ]
    "multimedia" => array:7 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 777
            "Ancho" => 1577
            "Tamanyo" => 58843
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Distribution by age&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 942
            "Ancho" => 1570
            "Tamanyo" => 58150
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Distribution of mucocutaneous infections&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "fig0015"
        "etiqueta" => "Figure 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
            "Alto" => 924
            "Ancho" => 1554
            "Tamanyo" => 102559
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Distribution of eczema&#46;</p>"
        ]
      ]
      3 => array:7 [
        "identificador" => "fig0020"
        "etiqueta" => "Figure 4"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr4.jpeg"
            "Alto" => 891
            "Ancho" => 1577
            "Tamanyo" => 90773
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Percentage of each supplementary test in relation to the total of tests requested&#46;</p>"
        ]
      ]
      4 => array:7 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:1 [
          "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=""><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">By ages</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Infants&#58; 0&#8211;1 year&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Early childhood&#58; 1&#8211;2 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Preschool-aged children&#58; 2&#8211;6 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>School-aged children&#58; 6&#8211;12 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Children in puberty&#58; 12&#8211;14 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">By diseases</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Seventeen groups of related diseases&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>A group of low-prevalence conditions&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>A group where patients with no diagnosis after being assisted was included&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Another group where patients who failed to attend their appointment was included&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab976859.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Grouping of data according to age and groups of diseases&#46;</p>"
        ]
      ]
      5 => array:7 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Data expressed as <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&#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  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Group of diagnosis&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">Infants&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">Early childhood&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">Pre-schoolers&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">School-aged&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">Children in puberty&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">Total&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  " align="left" valign="top">Eczemas&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;36&#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;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">72 &#40;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">48 &#40;21&#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;16&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">229 &#40;27&#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  " align="left" valign="top">Infections&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;13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">29 &#40;23&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">77 &#40;29&#41;&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;34&#41;&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;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">227 &#40;26&#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  " align="left" valign="top">Bites&#46; Prurigo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;4&#41;&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;11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">28 &#40;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11 &#40;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">4 &#40;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">63 &#40;7&#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  " align="left" valign="top">Erythematous dermatitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;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">4 &#40;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">17 &#40;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">29 &#40;13&#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 &#40;8&#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;7&#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  " align="left" valign="top">Tumours&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8 &#40;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">10 &#40;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11 &#40;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15 &#40;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">9 &#40;12&#41;&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;6&#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  " align="left" valign="top">Miscellaneous&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17 &#40;11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;4&#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;4&#41;&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;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">3 &#40;4&#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;5&#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  " align="left" valign="top">Failed to attend&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;4&#41;&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;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">12 &#40;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10 &#40;4&#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 &#40;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">41 &#40;5&#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  " align="left" valign="top">Related diseases&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;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">2 &#40;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">12 &#40;4&#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;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;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">31 &#40;4&#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  " align="left" valign="top">Vascular anomalies&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">19 &#40;12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;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">2 &#40;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">5 &#40;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 &#40;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">28 &#40;3&#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  " align="left" valign="top">Urticaria&#47;angioedema&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;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">5 &#40;4&#41;&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;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">6 &#40;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">2 &#40;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">25 &#40;3&#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  " align="left" valign="top">Pigmentation alterations&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;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">2 &#40;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">3 &#40;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 &#40;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">1 &#40;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">10 &#40;1&#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  " align="left" valign="top">Vasculitis and panniculitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;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 &#40;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">2 &#40;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">2 &#40;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">3 &#40;4&#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;1&#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  " align="left" valign="top">Photodermatosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;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 &#40;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">3 &#40;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">3 &#40;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 &#40;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">8 &#40;1&#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  " align="left" valign="top">Reactive dermatosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;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">4 &#40;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">0 &#40;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">2 &#40;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 &#40;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">8 &#40;1&#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  " align="left" valign="top">Toxicodermy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;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">1 &#40;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">3 &#40;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">2 &#40;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 &#40;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">7 &#40;1&#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  " align="left" valign="top">Dermatosis caused by physical or mechanical agents&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;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 &#40;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">3 &#40;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">2 &#40;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 &#40;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">7 &#40;1&#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  " align="left" valign="top">Mouth and lips diseases&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;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 &#40;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 &#40;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">1 &#40;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">0 &#40;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">4 &#40;0&#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  " align="left" valign="top">Genodermatosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;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 &#40;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">2 &#40;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 &#40;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">0 &#40;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">3 &#40;0&#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  " align="left" valign="top">Unknown diagnosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;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 &#40;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">0 &#40;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">0 &#40;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">1 &#40;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">3 &#40;0&#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  " align="left" valign="top">Bollous dermatosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;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">0 &#40;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">2 &#40;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 &#40;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">0 &#40;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">2 &#40;0&#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  " align="left" valign="top">Total overall&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">159 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">126 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">268 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">232 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">76 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">861 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab976861.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Distribution of the groups of diseases according to age groups&#46;</p>"
        ]
      ]
      6 => array:7 [
        "identificador" => "tbl0015"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:1 [
          "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  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Diagnosis&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"><span class="elsevierStyleItalic">n</span> &#40;&#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" title="table-entry  " align="left" valign="top">Atopic dermatitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">142 &#40;17&#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  " align="left" valign="top">Prurigo&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;5&#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  " align="left" valign="top">Dermatophytosis&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;5&#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  " align="left" valign="top">Pyogenic granuloma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">35 &#40;4&#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  " align="left" valign="top"><span class="elsevierStyleItalic">Molluscum contagiosum</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">34 &#40;4&#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  " align="left" valign="top">Impetigo&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;4&#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  " align="left" valign="top">Gianotti&#8211;Crosti syndrome&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;3&#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  " align="left" valign="top">Seborrheic dermatitis&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;3&#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  " align="left" valign="top">Scabies&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22 &#40;3&#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  " align="left" valign="top">Contact dermatitis&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;2&#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  " align="left" valign="top">Bites&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18 &#40;2&#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  " align="left" valign="top">Urticaria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18 &#40;2&#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  " align="left" valign="top">Pityriasis rosea&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18 &#40;2&#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  " align="left" valign="top">Child haemangioma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17 &#40;2&#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  " align="left" valign="top">Psoriasis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15 &#40;2&#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  " align="left" valign="top">Dyshidrotic eczema&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;2&#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  " align="left" valign="top">Herpes zoster&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13 &#40;2&#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  " align="left" valign="top">Diaper dermatitis&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;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab976860.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Main diagnoses issued at the Emergency room in general paediatric population&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:17 [
            0 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "An&#225;lisis de las urgencias dermatol&#243;gicas en el servicio de urgencias de un hospital comarcal"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46;P&#46; Gil Mateo"
                            1 => "M&#46; Velasco Pastor"
                            2 => "J&#46;B&#46; Miquel Miquel"
                            3 => "E&#46; Quecedo Est&#233;banez"
                            4 => "J&#46;A&#46; Mart&#237;nez Escribano"
                            5 => "E&#46; Nagore Enguidanos"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Actas Dermosifiliogr"
                        "fecha" => "1996"
                        "volumen" => "87"
                        "paginaInicial" => "305"
                        "paginaFinal" => "309"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Urgencias dermatol&#243;gicas en un hospital de referencia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "A&#46; Gonz&#225;lez Ruiz"
                            1 => "A&#46;I&#46; Bernal Ruiz"
                            2 => "M&#46; Garc&#237;a Mu&#241;oz"
                            3 => "A&#46; Miranda Romero"
                            4 => "J&#46; Castrodeza Sanz"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Actas Dermosifiliogr"
                        "fecha" => "2001"
                        "volumen" => "92"
                        "paginaInicial" => "342"
                        "paginaFinal" => "348"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Consultas dermatol&#243;gicas en el Servicio de Urgencias&#58; situaci&#243;n previa a la instauraci&#243;n de guardias de la especialidad"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "M&#46;L&#46; Mart&#237;nez-Mart&#237;nez"
                            1 => "E&#46; Escario-Travesedo"
                            2 => "M&#46; Rodr&#237;guez-V&#225;zquez"
                            3 => "J&#46;M&#46; Aza&#241;a-Defez"
                            4 => "M&#46;C&#46; Mart&#237;n de Hijas-Santos"
                            5 => "L&#46; Juan-P&#233;rez-Garc&#237;a"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ad.2010.04.011"
                      "Revista" => array:6 [
                        "tituloSerie" => "Actas Dermosifiliogr"
                        "fecha" => "2011"
                        "volumen" => "102"
                        "paginaInicial" => "39"
                        "paginaFinal" => "47"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21315860"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0105"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "An&#225;lisis de las urgencias dermatol&#243;gicas en el Servicio de Urgencias de un hospital comarcal"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "F&#46; Valcuende"
                            1 => "C&#46; Ferraz"
                            2 => "G&#46; Tom&#225;s"
                            3 => "A&#46; Pitarch"
                            4 => "T&#46; Almela"
                            5 => "F&#46; Bertom&#233;u"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Actas Dermosifiliogr"
                        "fecha" => "1996"
                        "volumen" => "76"
                        "paginaInicial" => "676"
                        "paginaFinal" => "680"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0110"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Urgencias dermatol&#243;gicas pedi&#225;tricas en un hospital terciario"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "C&#46; Roca Saurina"
                            1 => "A&#46;C&#46; L&#225;zaro Tremul"
                            2 => "A&#46; Vicente Molinero"
                            3 => "A&#46; Larumbe Irurzun"
                            4 => "M&#46;P&#46; Grasa Jord&#225;n"
                            5 => "F&#46;J&#46; Carapeto"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Piel"
                        "fecha" => "2004"
                        "volumen" => "19"
                        "paginaInicial" => "124"
                        "paginaFinal" => "130"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0115"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Urgencias dermatol&#243;gicas&#58; an&#225;lisis descriptivo de 861 pacientes en un hospital terciario"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "E&#46; Grillo"
                            1 => "S&#46; Va&#241;&#243;-Galv&#225;n"
                            2 => "N&#46; Jim&#233;nez-G&#243;mez"
                            3 => "A&#46; Ballester"
                            4 => "E&#46; Mu&#241;oz-Zato"
                            5 => "P&#46; Ja&#233;n"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.adengl.2013.03.003"
                      "Revista" => array:6 [
                        "tituloSerie" => "Actas Dermosifiliogr"
                        "fecha" => "2013"
                        "volumen" => "104"
                        "paginaInicial" => "316"
                        "paginaFinal" => "324"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23582734"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0120"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Urgencias en dermatolog&#237;a"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "M&#46; Ribera"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Actas Dermosifiliogr"
                        "fecha" => "1997"
                        "volumen" => "88"
                        "paginaInicial" => "353"
                        "paginaFinal" => "357"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0125"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Urgencias en dermatolog&#237;a"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "R&#46; Su&#225;rez Fern&#225;ndez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Piel"
                        "fecha" => "2009"
                        "volumen" => "24"
                        "paginaInicial" => "463"
                        "paginaFinal" => "464"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0130"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Estudio del &#225;rea de Urgencias de un hospital general&#46; Grado de adecuaci&#243;n de las visitas"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "M&#46; Del Castillo"
                            1 => "J&#46; Huguet"
                            2 => "J&#46; Brabo"
                            3 => "L&#46; Cortada"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Med Clin &#40;Barc&#41;"
                        "fecha" => "1986"
                        "volumen" => "87"
                        "paginaInicial" => "539"
                        "paginaFinal" => "542"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0135"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Caracter&#237;sticas de la utilizaci&#243;n del Servicio de Urgencias en un hospital comarcal"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "A&#46; Castillo"
                            1 => "N&#46; Mart&#237;nez"
                            2 => "L&#46; Ferr&#250;s"
                            3 => "E&#46; Portella"
                            4 => "J&#46; Roma"
                            5 => "L&#46; Triquell"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Gac Sanit"
                        "fecha" => "1986"
                        "volumen" => "5"
                        "paginaInicial" => "190"
                        "paginaFinal" => "193"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0140"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Urgencias en dermatolog&#237;a"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "J&#46; L&#243;pez"
                            1 => "D&#46; Argila"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Arch Dermatol &#40;ed esp&#41;"
                        "fecha" => "1996"
                        "volumen" => "7"
                        "paginaInicial" => "54"
                        "paginaFinal" => "64"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0145"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Demanda pedi&#225;trica en urgencias de un hospital general"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "L&#46; Colom&#233;s"
                            1 => "A&#46; Lorenzo"
                            2 => "R&#46; Ort&#237;n"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Aten Primaria"
                        "fecha" => "1987"
                        "volumen" => "6"
                        "paginaInicial" => "130"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2519766"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0150"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Estudio de la demanda asistencial de un servicio de urgencias hospitalario de pediatr&#237;a"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; S&#225;nchez Bayle"
                            1 => "E&#46; D&#237;az Mart&#237;nez"
                            2 => "J&#46;C&#46; Molina Caba&#241;ero"
                            3 => "R&#46; Mu&#241;oz Ordu&#241;a"
                            4 => "A&#46; Arias Alvarez"
                            5 => "C&#46; Panizo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "An Esp Pediatr"
                        "fecha" => "1989"
                        "volumen" => "31"
                        "paginaInicial" => "127"
                        "paginaFinal" => "133"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2490315"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0155"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Estudio epidemiol&#243;gico de las urgencias pedi&#225;tricas en un hospital general&#46; Factores implicados en una demanda inadecuada"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "S&#46; Lape&#241;a L&#243;pez de Armentia"
                            1 => "S&#46; Reguero Celada"
                            2 => "M&#46; Garc&#237;a Rabanal"
                            3 => "M&#46; Guti&#233;rrez Fern&#225;ndez"
                            4 => "I&#46; Abdallah"
                            5 => "H&#46; Gonz&#225;lez Aparicio"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "An Esp Pediatr"
                        "fecha" => "1996"
                        "volumen" => "44"
                        "paginaInicial" => "121"
                        "paginaFinal" => "125"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8830569"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0160"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Demanda inadecuada en un servicio de urgencias pedi&#225;trico hospitalario&#58; factores implicados"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "M&#46;D&#46; Ant&#243;n"
                            1 => "J&#46;C&#46; Pe&#241;a"
                            2 => "R&#46; Santos"
                            3 => "E&#46; Sempere"
                            4 => "J&#46; Mart&#237;nez"
                            5 => "L&#46;A&#46; P&#233;rula"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Med Clin &#40;Barc&#41;"
                        "fecha" => "1992"
                        "volumen" => "99"
                        "paginaInicial" => "743"
                        "paginaFinal" => "746"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0165"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Estudio de concordancia diagn&#243;stica en Dermatolog&#237;a entre Atenci&#243;n Primaria y Especializada en el &#225;rea de salud de un hospital de referencia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "N&#46; Porta"
                            1 => "J&#46; San Juan"
                            2 => "M&#46;P&#46; Grasc"
                            3 => "E&#46; Simal"
                            4 => "M&#46; Ara"
                            5 => "I&#46; Querol"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Actas Dermosifiliogr"
                        "fecha" => "2008"
                        "volumen" => "99"
                        "paginaInicial" => "207"
                        "paginaFinal" => "212"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18358196"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0170"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Diagnosis of skin disease by nondermatologists"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "A&#46;B&#46; Fleischer Jr&#46;"
                            1 => "C&#46;R&#46; Herbert"
                            2 => "S&#46; Feldman"
                            3 => "F&#46; O&#8217;Brien"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Manag Care"
                        "fecha" => "2000"
                        "volumen" => "6"
                        "paginaInicial" => "1149"
                        "paginaFinal" => "1156"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11184670"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/23412879/0000008300000006/v2_201601190027/S2341287915001714/v2_201601190027/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "26005"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Original Articles"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/23412879/0000008300000006/v2_201601190027/S2341287915001714/v2_201601190027/en/main.pdf?idApp=UINPBA00005H&text.app=https://analesdepediatria.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287915001714?idApp=UINPBA00005H"
]

Article information

ISSN: 23412879
Original language: English

DOI:10.1016/j.anpede.2015.09.008

The statistics are updated each day

Year/Month	Html	Pdf	Total

2024 November	8	9	17
2024 October	53	55	108
2024 September	73	53	126
2024 August	70	73	143
2024 July	53	44	97
2024 June	67	26	93
2024 May	68	45	113
2024 April	62	34	96
2024 March	65	29	94
2024 February	66	33	99
2024 January	60	20	80
2023 December	58	25	83
2023 November	71	24	95
2023 October	59	31	90
2023 September	31	24	55
2023 August	47	14	61
2023 July	60	29	89
2023 June	44	33	77
2023 May	57	31	88
2023 April	53	32	85
2023 March	45	28	73
2023 February	41	23	64
2023 January	22	27	49
2022 December	30	32	62
2022 November	49	33	82
2022 October	35	47	82
2022 September	29	42	71
2022 August	44	50	94
2022 July	24	37	61
2022 June	35	36	71
2022 May	35	42	77
2022 April	40	40	80
2022 March	53	49	102
2022 February	41	32	73
2022 January	41	34	75
2021 December	50	51	101
2021 November	54	48	102
2021 October	128	54	182
2021 September	45	43	88
2021 August	28	42	70
2021 July	35	26	61
2021 June	41	41	82
2021 May	29	31	60
2021 April	76	61	137
2021 March	53	37	90
2021 February	38	13	51
2021 January	56	31	87
2020 December	63	21	84
2020 November	52	25	77
2020 October	65	19	84
2020 September	73	25	98
2020 August	48	11	59
2020 July	46	30	76
2020 June	45	13	58
2020 May	64	28	92
2020 April	33	17	50
2020 March	40	18	58
2020 February	33	12	45
2020 January	28	23	51
2019 December	58	27	85
2019 November	30	17	47
2019 October	47	21	68
2019 September	30	15	45
2019 August	59	19	78
2019 July	31	24	55
2019 June	42	26	68
2019 May	127	25	152
2019 April	47	24	71
2019 March	39	23	62
2019 February	42	23	65
2019 January	35	24	59
2018 December	36	24	60
2018 November	109	25	134
2018 October	160	32	192
2018 September	73	20	93
2018 August	2	0	2
2018 July	4	0	4
2018 June	4	0	4
2018 May	7	0	7
2018 April	37	0	37
2018 March	56	0	56
2018 February	40	0	40
2018 January	9	0	9
2017 December	64	0	64
2017 November	16	0	16
2017 October	16	0	16
2017 September	13	0	13
2017 August	16	0	16
2017 July	20	1	21
2017 June	24	8	32
2017 May	20	6	26
2017 April	8	8	16
2017 March	4	3	7
2017 February	13	8	21
2017 January	6	3	9
2016 December	28	5	33
2016 November	25	11	36
2016 October	27	5	32
2016 September	26	10	36
2016 August	27	7	34
2016 July	6	0	6

Show all

Indexed in:

Follow us:

Subscribe:

Statistics

Indexed in:

Follow us:

Subscribe:

Statistics

Subscribe to our newsletter