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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The detection of child abuse is essential to allow adequate intervention with the aim of improving the situation of the patient and prevent its recurrence&#46; Emergency departments &#40;EDs&#41; are the main point of entry to the health care system for many patients&#44; yet several studies have demonstrated that detection of abuse could improve in the emergency care setting&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The challenge posed by the differential diagnosis of many injuries&#44; in which abuse may be confused with accidental&#44; infectious or neurologic aetiologies&#44; combined with the heavy workloads in EDs&#44; results in failure to detect abuse in some instances&#44; which may have significant consequences for the child&#46; Due to these difficulties&#44; different screening methods have been developed that are used routinely in in some countries&#44;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a> but not in Spain&#44; where their application has not been studied&#46; In this context&#44; the Working Group on Abuse of the Sociedad Espa&#241;ola de Urgencias Pedi&#225;tricas &#40;Spanish Society of Paediatric Emergency Medicine&#44; SEUP&#41; carried out a multicentre study to assess the tools used to screen for abuse in paediatric EDs in Spain&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">We designed an observational descriptive study with data collection by means of questionnaires&#46; The study was approved by the clinical research ethics committee of the hospital&#46; In November 2018&#44; we contacted the directors of the EDs affiliated with the SEUP to request their participation in the study&#46; We provided the link to an online questionnaire and sent 2 reminders by email in the 2 months that followed&#46; The questionnaire included items about the characteristics of the ED&#44; the methods used for detection of abuse&#44; the existence and type of child abuse protocol and its availability&#46; We contacted 80 directors and received responses from 39 of them &#40;48&#46;8&#37;&#41;&#44; corresponding to hospitals in 16 autonomous communities of Spain&#46; <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> presents the characteristics of participating hospitals&#46; In every hospital&#44; abuse was suspected based on the findings of the history and the physical examination&#46; None of the hospitals used a standardised abuse screening tool&#44; and 5 &#40;12&#46;8&#37;&#41; were planning introducing one in the near future&#46; Thirty-seven hospitals &#40;94&#46;9&#37;&#41; had a child abuse protocol in place in the emergency care setting &#40;29 an in-house protocol and 8 a regional protocol&#41; and 33 &#40;84&#46;6&#37;&#41; reported that the staff was acquainted with the protocol&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Based on our findings&#44; we surmise that the suspicion of abuse in EDs depends exclusively on the ability of physicians to identify it&#44; which in turn depends greatly on their training and experience on the subject&#46; It is also worth noting that a large proportion of hospitals still did not fulfil the child abuse quality indicator established by the SEUP&#44;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> which involves the existence of a child abuse protocol accessible to the ED staff&#44; who in turn should be aware of its location&#46; The lack of standardization involves a considerable heterogeneity in the approach to the identification of abuse&#44; so that existing cases may go undetected&#44; even severe ones&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> If we increase the frequency of early detection&#44; the outcomes of these children may improve&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;5</span></a> A recent study found that the use of a screening checklist such as the SPUTOVAMO combined with a top-to-toe physical examination of all patients that visited the ED was a good method for detection of possible cases of abuse&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> On the other hand&#44; Rumball-Smith et al&#46; have advocated for the integration of a child abuse screening tool in the electronic health record system to be completed for every patient&#44; as the authors observed an increase in the number of reported cases of suspected abuse&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> However&#44; depending on the level of care and workload of each hospital&#44; these strategies may be difficult to implement in Spain&#46; One option&#44; perhaps as a first step to improve detection&#44; is to programme red flag alerts in the electronic health record system to be triggered with certain discharge diagnoses to alert the physician in charge of the potential of abuse before the patient is discharged&#46; This would give the physician the opportunity to complete the child abuse checklist and review all the records shared in the system before discharging the patient&#44; or to start an evaluation to address this suspicion&#46; A similar option is being investigated for implementation in primary care clinics in Catalonia&#44; and we believe that its implementation in EDs would be feasible&#46; For this or other strategies&#44; it is essential that patient records are available electronically and that the information contained in the electronic health records can be shared by the health care staff of different facilities while safeguarding confidentiality&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">In conclusion&#44; given the deficiencies observed in the EDs under study&#44; it is our duty as specialist in paediatric emergency care to promote the knowledge and implantation of screening tools and to disseminate existing screening protocols to attempt to improve the care of potential victims of abuse and reduce its potential impact&#46;</p></span>"
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">92&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="3" align="left" valign="\n
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                  \t\t\t\t">&#91;0&#46;1&#8211;3&#93;</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">43&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">43&#46;6&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                      "titulo" => "Screening methods to detect child maltreatment&#58; high variability in Dutch emergency departments"
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                            1 => "A&#46;H&#46; Teeuw"
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                        0 => array:2 [
                          "etal" => true
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                            1 => "J&#46; Fromkin"
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                      "doi" => "10.1016/j.chiabu.2018.08.008"
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                        "tituloSerie" => "Child Abuse Neglect"
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                            0 => "E&#46;C&#46; Louwers"
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                            2 => "H&#46;A&#46; Moll"
                            3 => "H&#46;J&#46; de Koning"
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                      "titulo" => "Accuracy of a screening instrument to identify potential child abuse in emergency departments"
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                            0 => "E&#46;C&#46; Louwers"
                            1 => "I&#46;J&#46; Korfage"
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                            3 => "M&#46; Ruige"
                            4 => "A&#46;P&#46; van den Elzen"
                            5 => "H&#46;J&#46; de Koning"
                            6 => "H&#46;A&#46; Moll"
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                      "doi" => "10.1016/j.chiabu.2013.11.005"
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                        "fecha" => "2014"
                        "volumen" => "38"
                        "paginaInicial" => "1275"
                        "paginaFinal" => "1281"
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                    0 => array:2 [
                      "titulo" => "Screening for child abuse using a checklist and physical examinations in the emergency department led to the detection of more cases"
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                          "etal" => false
                          "autores" => array:5 [
                            0 => "A&#46;H&#46; Teeuw"
                            1 => "R&#46;B&#46;J&#46; Kraan"
                            2 => "R&#46;R&#46; van Rijn"
                            3 => "P&#46;M&#46;M&#46; Bossuyt"
                            4 => "H&#46;S&#46;A&#46; Heymans"
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                        "tituloSerie" => "Acta Paediatr"
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                        "volumen" => "108"
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        "texto" => "<p id="par0025" class="elsevierStylePara elsevierViewall">We thank the directors of the EDs of the following hospitals that participated in the study&#58; Hospital de Barbastro&#44; Hospital Comarcal San Juan de la Cruz de &#218;beda&#44; Hospital Virgen de Altagracia Manzanares&#44; Hospital General San Jorge &#40;Huesca&#41;&#44; Hospital de Laredo&#44; Hospital de Mendaro&#44; Hospital Universitario San Agust&#237;n de Avil&#233;s&#44; Hospital San Agust&#237;n de Linares&#44; Hospital Ram&#243;n y Cajal &#40;Madrid&#41;&#44; Hospital Universitario Francesc de Borja &#40;Gand&#237;a&#41;&#44; Hospital Universitario de Cabue&#241;es&#44; Hospital General de Granollers&#44; Hospital Arnau de Vilanova de Lleida&#44; Hospital Royo Villanova &#40;Zaragoza&#41;&#44; Hospital Universitario R&#237;o Hortega &#40;Valladolid&#41;&#44; Hospital Universitario Fundaci&#243;n Alcorc&#243;n&#44; Hospital San Juan de Dios del Aljarafe &#40;Bormujos&#41;&#44; Hospital Infanta Cristina &#40;Badajoz&#41;&#44; Hospital Universitario Puerta del Mar &#40;Cadiz&#41;&#44; Hospital Universitario Basurto&#44; Consorci Sanitari de Terrassa&#44; Hospital Universitario de Fuenlabrada&#44; Complejo Hospitalario Universitario de Albacete&#44; Hospital de la Santa Creu i de Sant Pau &#40;Barcelona&#41;&#44; Hospital Universitario Infanta Sof&#237;a &#40;Madrid&#41;&#44; Hospital Universitario Son Espases &#40;Majorca&#41;&#44; Hospital Universitario Pr&#237;ncipe de Asturias &#40;Alcal&#225; de Henares&#41;&#44; Hospital Materno Infantil Teresa Herrera &#40;A Coru&#241;a&#41;&#44; Hospital Parc Taul&#237; de Sabadell&#44; Hospital General Universitario Santa Lucia &#40;Murcia&#41;&#44; Hospital Vall d&#39;Hebron &#40;Barcelona&#41;&#44; Complejo Hospitalario Navarra&#44; Complejo Hospitalario Universitario Insular Materno Infantil &#40;Las Palmas&#41;&#44; Hospital Miguel Servet &#40;Zaragoza&#41;&#44; Hospital Universitario Cruces &#40;Barakaldo&#41;&#44; Hospital Gregorio Mara&#241;&#243;n &#40;Madrid&#41;&#44; Hospital Virgen de las Nieves &#40;Granada&#41;&#44; Hospital Cl&#237;nico Universitario Virgen de la Arrixaca &#40;Murcia&#41;&#44; Hospital Sant Joan de D&#233;u &#40;Barcelona&#41;&#46;</p>"
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Scientific letter
Screening for abuse in emergency departments: A pending issue
Cribado de maltrato en urgencias, una asignatura pendiente
Ana I. Curcoya,b,
Corresponding author
, Victoria Trenchsa,b, Working Group on Abuse of the Sociedad Española de Urgencias Pediátricas (SEUP) 1
a Influencia del entorno en el bienestar del niño y del adolescente, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
b Servicio de Urgencias de Pediatría, Hospital Sant Joan de Déu Barcelona, Esplugues de Llobregat, Barcelona, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The detection of child abuse is essential to allow adequate intervention with the aim of improving the situation of the patient and prevent its recurrence&#46; Emergency departments &#40;EDs&#41; are the main point of entry to the health care system for many patients&#44; yet several studies have demonstrated that detection of abuse could improve in the emergency care setting&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The challenge posed by the differential diagnosis of many injuries&#44; in which abuse may be confused with accidental&#44; infectious or neurologic aetiologies&#44; combined with the heavy workloads in EDs&#44; results in failure to detect abuse in some instances&#44; which may have significant consequences for the child&#46; Due to these difficulties&#44; different screening methods have been developed that are used routinely in in some countries&#44;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a> but not in Spain&#44; where their application has not been studied&#46; In this context&#44; the Working Group on Abuse of the Sociedad Espa&#241;ola de Urgencias Pedi&#225;tricas &#40;Spanish Society of Paediatric Emergency Medicine&#44; SEUP&#41; carried out a multicentre study to assess the tools used to screen for abuse in paediatric EDs in Spain&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">We designed an observational descriptive study with data collection by means of questionnaires&#46; The study was approved by the clinical research ethics committee of the hospital&#46; In November 2018&#44; we contacted the directors of the EDs affiliated with the SEUP to request their participation in the study&#46; We provided the link to an online questionnaire and sent 2 reminders by email in the 2 months that followed&#46; The questionnaire included items about the characteristics of the ED&#44; the methods used for detection of abuse&#44; the existence and type of child abuse protocol and its availability&#46; We contacted 80 directors and received responses from 39 of them &#40;48&#46;8&#37;&#41;&#44; corresponding to hospitals in 16 autonomous communities of Spain&#46; <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> presents the characteristics of participating hospitals&#46; In every hospital&#44; abuse was suspected based on the findings of the history and the physical examination&#46; None of the hospitals used a standardised abuse screening tool&#44; and 5 &#40;12&#46;8&#37;&#41; were planning introducing one in the near future&#46; Thirty-seven hospitals &#40;94&#46;9&#37;&#41; had a child abuse protocol in place in the emergency care setting &#40;29 an in-house protocol and 8 a regional protocol&#41; and 33 &#40;84&#46;6&#37;&#41; reported that the staff was acquainted with the protocol&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Based on our findings&#44; we surmise that the suspicion of abuse in EDs depends exclusively on the ability of physicians to identify it&#44; which in turn depends greatly on their training and experience on the subject&#46; It is also worth noting that a large proportion of hospitals still did not fulfil the child abuse quality indicator established by the SEUP&#44;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> which involves the existence of a child abuse protocol accessible to the ED staff&#44; who in turn should be aware of its location&#46; The lack of standardization involves a considerable heterogeneity in the approach to the identification of abuse&#44; so that existing cases may go undetected&#44; even severe ones&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> If we increase the frequency of early detection&#44; the outcomes of these children may improve&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;5</span></a> A recent study found that the use of a screening checklist such as the SPUTOVAMO combined with a top-to-toe physical examination of all patients that visited the ED was a good method for detection of possible cases of abuse&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> On the other hand&#44; Rumball-Smith et al&#46; have advocated for the integration of a child abuse screening tool in the electronic health record system to be completed for every patient&#44; as the authors observed an increase in the number of reported cases of suspected abuse&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> However&#44; depending on the level of care and workload of each hospital&#44; these strategies may be difficult to implement in Spain&#46; One option&#44; perhaps as a first step to improve detection&#44; is to programme red flag alerts in the electronic health record system to be triggered with certain discharge diagnoses to alert the physician in charge of the potential of abuse before the patient is discharged&#46; This would give the physician the opportunity to complete the child abuse checklist and review all the records shared in the system before discharging the patient&#44; or to start an evaluation to address this suspicion&#46; A similar option is being investigated for implementation in primary care clinics in Catalonia&#44; and we believe that its implementation in EDs would be feasible&#46; For this or other strategies&#44; it is essential that patient records are available electronically and that the information contained in the electronic health records can be shared by the health care staff of different facilities while safeguarding confidentiality&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">In conclusion&#44; given the deficiencies observed in the EDs under study&#44; it is our duty as specialist in paediatric emergency care to promote the knowledge and implantation of screening tools and to disseminate existing screening protocols to attempt to improve the care of potential victims of abuse and reduce its potential impact&#46;</p></span>"
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">12&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">92&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#91;0&#46;1&#8211;3&#93;</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="3" align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">43&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>25 000 &#8211; 50 000&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">17&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">43&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#62; 50 000&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">12&#46;8&nbsp;\t\t\t\t\t\t\n
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Characteristics of participating hospitals &#40;<span class="elsevierStyleItalic">n</span>&#8239;&#61;&#8239;39&#41;&#46;</p>"
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                    0 => array:2 [
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                      "autores" => array:1 [
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                            1 => "A&#46;H&#46; Teeuw"
                            2 => "S&#46;A&#46; Zwaard"
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                            4 => "R&#46;R&#46; van Rijn"
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                    0 => array:2 [
                      "doi" => "10.1136/emermed-2013-202733"
                      "Revista" => array:6 [
                        "tituloSerie" => "Emerg Med J"
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            1 => array:3 [
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                      "titulo" => "Implementation of routine electronic health record-based child abuse screening in General Emergency Departments"
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                        0 => array:2 [
                          "etal" => true
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                            0 => "J&#46; Rumball-Smith"
                            1 => "J&#46; Fromkin"
                            2 => "B&#46; Rosenthal"
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                            4 => "J&#46; Skrbin"
                            5 => "T&#46; Bimber"
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                    0 => array:2 [
                      "doi" => "10.1016/j.chiabu.2018.08.008"
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                        "tituloSerie" => "Child Abuse Neglect"
                        "fecha" => "2018"
                        "volumen" => "85"
                        "paginaInicial" => "58"
                        "paginaFinal" => "67"
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30170921"
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              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:1 [
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                      "titulo" => "Screening for child abuse at emergency departments&#58; a systematic review"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "E&#46;C&#46; Louwers"
                            1 => "M&#46;J&#46; Affourtit"
                            2 => "H&#46;A&#46; Moll"
                            3 => "H&#46;J&#46; de Koning"
                            4 => "I&#46;J&#46; Korfage"
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                      "doi" => "10.1136/adc.2008.151654"
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                        "tituloSerie" => "Arch Dis Child"
                        "fecha" => "2010"
                        "volumen" => "95"
                        "paginaInicial" => "214"
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                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19773222"
                            "web" => "Medline"
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                ]
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              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Accuracy of a screening instrument to identify potential child abuse in emergency departments"
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                          "etal" => false
                          "autores" => array:7 [
                            0 => "E&#46;C&#46; Louwers"
                            1 => "I&#46;J&#46; Korfage"
                            2 => "M&#46;J&#46; Affourtit"
                            3 => "M&#46; Ruige"
                            4 => "A&#46;P&#46; van den Elzen"
                            5 => "H&#46;J&#46; de Koning"
                            6 => "H&#46;A&#46; Moll"
                          ]
                        ]
                      ]
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                    0 => array:2 [
                      "doi" => "10.1016/j.chiabu.2013.11.005"
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                        "tituloSerie" => "Child Abuse Negl"
                        "fecha" => "2014"
                        "volumen" => "38"
                        "paginaInicial" => "1275"
                        "paginaFinal" => "1281"
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                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24325939"
                            "web" => "Medline"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Screening for child abuse using a checklist and physical examinations in the emergency department led to the detection of more cases"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "A&#46;H&#46; Teeuw"
                            1 => "R&#46;B&#46;J&#46; Kraan"
                            2 => "R&#46;R&#46; van Rijn"
                            3 => "P&#46;M&#46;M&#46; Bossuyt"
                            4 => "H&#46;S&#46;A&#46; Heymans"
                          ]
                        ]
                      ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/apa.14495"
                      "Revista" => array:6 [
                        "tituloSerie" => "Acta Paediatr"
                        "fecha" => "2019"
                        "volumen" => "108"
                        "paginaInicial" => "300"
                        "paginaFinal" => "313"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29992712"
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        "titulo" => "Acknowledgments"
        "texto" => "<p id="par0025" class="elsevierStylePara elsevierViewall">We thank the directors of the EDs of the following hospitals that participated in the study&#58; Hospital de Barbastro&#44; Hospital Comarcal San Juan de la Cruz de &#218;beda&#44; Hospital Virgen de Altagracia Manzanares&#44; Hospital General San Jorge &#40;Huesca&#41;&#44; Hospital de Laredo&#44; Hospital de Mendaro&#44; Hospital Universitario San Agust&#237;n de Avil&#233;s&#44; Hospital San Agust&#237;n de Linares&#44; Hospital Ram&#243;n y Cajal &#40;Madrid&#41;&#44; Hospital Universitario Francesc de Borja &#40;Gand&#237;a&#41;&#44; Hospital Universitario de Cabue&#241;es&#44; Hospital General de Granollers&#44; Hospital Arnau de Vilanova de Lleida&#44; Hospital Royo Villanova &#40;Zaragoza&#41;&#44; Hospital Universitario R&#237;o Hortega &#40;Valladolid&#41;&#44; Hospital Universitario Fundaci&#243;n Alcorc&#243;n&#44; Hospital San Juan de Dios del Aljarafe &#40;Bormujos&#41;&#44; Hospital Infanta Cristina &#40;Badajoz&#41;&#44; Hospital Universitario Puerta del Mar &#40;Cadiz&#41;&#44; Hospital Universitario Basurto&#44; Consorci Sanitari de Terrassa&#44; Hospital Universitario de Fuenlabrada&#44; Complejo Hospitalario Universitario de Albacete&#44; Hospital de la Santa Creu i de Sant Pau &#40;Barcelona&#41;&#44; Hospital Universitario Infanta Sof&#237;a &#40;Madrid&#41;&#44; Hospital Universitario Son Espases &#40;Majorca&#41;&#44; Hospital Universitario Pr&#237;ncipe de Asturias &#40;Alcal&#225; de Henares&#41;&#44; Hospital Materno Infantil Teresa Herrera &#40;A Coru&#241;a&#41;&#44; Hospital Parc Taul&#237; de Sabadell&#44; Hospital General Universitario Santa Lucia &#40;Murcia&#41;&#44; Hospital Vall d&#39;Hebron &#40;Barcelona&#41;&#44; Complejo Hospitalario Navarra&#44; Complejo Hospitalario Universitario Insular Materno Infantil &#40;Las Palmas&#41;&#44; Hospital Miguel Servet &#40;Zaragoza&#41;&#44; Hospital Universitario Cruces &#40;Barakaldo&#41;&#44; Hospital Gregorio Mara&#241;&#243;n &#40;Madrid&#41;&#44; Hospital Virgen de las Nieves &#40;Granada&#41;&#44; Hospital Cl&#237;nico Universitario Virgen de la Arrixaca &#40;Murcia&#41;&#44; Hospital Sant Joan de D&#233;u &#40;Barcelona&#41;&#46;</p>"
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Article information
ISSN: 23412879
Original language: English
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2022 April 27 29 56
2022 March 43 54 97
2022 February 29 24 53
2022 January 27 34 61
2021 December 41 44 85
2021 November 35 48 83
2021 October 46 69 115
2021 September 22 44 66
2021 August 21 35 56
2021 July 15 24 39
2021 June 26 36 62
2021 May 29 31 60
2021 April 107 74 181
2021 March 34 30 64
2021 February 29 29 58
2021 January 42 27 69
2020 December 68 22 90
2020 November 45 33 78
2020 October 26 21 47
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¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?