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few studies have been conducted on the aggressions experienced by health care workers in paediatric emergency departments &#40;PEDs&#41;&#46; Consequently&#44; we designed a study with the following objectives&#58; &#40;1&#41; to describe HBs in the PED of a children&#8217;s hospital and &#40;2&#41; to determine whether there were significant differences compared to other care settings in the same hospital&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">We conducted a single centre retrospective observational and descriptive study in a tertiary care children&#8217;s hospital serving medically complex patients&#46; In our hospital&#44; health care staff report experienced HBs on a voluntary basis through an electronic record system&#46; The following variables are documented in these reports&#58; care setting &#40;emergency care&#44; inpatient care&#44; outpatient clinics&#44; other&#41;&#44; professional category&#44; characteristics of the attack &#40;mild verbal&#44; verbal with gestures&#44; mild physical and property damage&#41;&#44; attacker&#44; reason for attack&#44; measures taken and impact on the health care worker&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The study included every recorded report &#40;after anonymization&#41; filed between September 2020 and September 2022&#46; The study was approved by the Research Ethics Committee of the hospital &#40;PIC-162-22&#41;&#46; The results were analysed with the statistical software SPSS version 25 for Windows &#40;IBM Corp&#46;&#44; Armonk&#44; NY&#44; USA&#41;&#46; In the descriptive analysis&#44; we summarised the data using the median and interquartile range &#40;quantitative variables&#41; or the frequency and percentage distribution &#40;categorical variables&#41;&#46; We used tests to analyse the distribution of the data&#44; to compare qualitative data &#40;&#967;<span class="elsevierStyleSup">2</span>&#44; contingency table&#44; Fisher exact test&#41;&#46; We considered <span class="elsevierStyleItalic">P</span> values of less than 0&#46;05 statistically significant&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">During the study period&#44; the health care staff of the hospital reported 205 attacks&#46; Fifty-seven HBs &#40;27&#46;8&#37;&#41; took place in the PED&#44; 95 &#40;46&#46;3&#37;&#41; in inpatient wards&#44; 33 &#40;16&#46;3&#37;&#41; in outpatient clinics and 20 &#40;9&#46;6&#37;&#41; in other settings &#40;gynaecology-obstetrics&#44; street&#41;&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Of the 57 HBs reported in the PED&#44; 38 were reported by nursing staff&#44; 11 by doctors and 8 by administrative staff&#46; The distribution by type of HB was 5 mild verbal attacks&#44; 43 verbal attacks accompanied by gestures and 9 mild physical attacks&#59; all the reported mild physical attacks took place in the context of restraining a patient&#46; The aggressor was a relative&#47;accompanying person in 44 cases and the patient in 13&#46; The reasons that triggered the HB as reported by staff were waiting times &#40;15&#41;&#44; disagreement with the rules &#40;12&#41;&#44; agitation &#40;12&#41;&#44; disagreement with care plan &#40;9&#41; and worry &#40;9&#41;&#46; <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a> presents the frequency distribution of the different types of reported HBs&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">The measures taken were verbal de-escalation &#40;57&#41;&#44; physical restraining &#40;10&#41;&#44; contacting security personnel &#40;12&#41;&#44; contacting the point person &#40;5&#41; and contacting the police &#40;4&#41;&#46; Eighteen professionals reported having psychological sequelae and 8 physical sequelae&#46; The psychological sequelae reported by the staff were discomfort &#40;9&#41;&#44; anxiety &#40;9&#41;&#44; worry &#40;3&#41;&#44; sadness &#40;2&#41; and fear &#40;2&#41;&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">When we compared the HBs described at the PED with those described in other hospital settings &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#44; we found statistically significant differences in terms of the professional category of the subject of attack&#44; the aggressor&#44; the type of HB and the trigger&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">Thus&#44; most HBs in the PED were verbal attacks with gestures on the part of relatives and&#47;or accompanying adults and the most frequent reasons were the wait times and disagreement with the rules of the department&#46; These results were consistent with other studies conducted in the adult emergency care setting&#44; although in this setting it is usually the patient who attacks the staff&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> In addition&#44; and also in agreement with the previous literature&#44; most HBs targeted nursing staff&#44; probably due to the closer and longer contact of nurses with patients&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">More aggressions were reported in inpatient care wards than in the PED&#44; although the frequency of attacks in the PED may have been underreported due to the substantial workloads or a shorter contact with families&#46; Furthermore&#44; in inpatient care&#44; physical attacks were more frequent and the proportion of HBs perpetrated by the patients was also greater&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Last of all&#44; nearly one third of the staff that had experienced an attack reported having some form of psychological sequelae&#44; although other authors have reported the presence of psychological disturbances in more than half of attacked professionals&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;5</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">In light of the above&#44; further research is required to create awareness and monitor the issue of aggression against health care workers&#46; In addition&#44; agencies and institutions must develop strategies at the local and regional level to prevent this form of violence&#44; manage these behaviours as they happen and follow-up with the staff to minimise their potential sequelae&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Webpage for data consultation</span><p id="par0065" class="elsevierStylePara elsevierViewall">Informe de Agresiones a profesionales del Sistema Nacional de Salud 2022 &#91;accessed 25 April 2024&#93;&#46; Available at&#58; <a href="https://www.sanidad.gob.es/areas/profesionesSanitarias/agresiones/docs/Informe_Agresiones.2022.pdf">https&#58;&#47;&#47;www&#46;sanidad&#46;gob&#46;es&#47;areas&#47;profesionesSanitarias&#47;agresiones&#47;docs&#47;Informe&#95;Agresiones&#46;2022&#46;pdf</a>&#46;</p></span></span>"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Types of hostile behaviours reported in the paediatric emergency department &#40;n&#8239;&#61;&#8239;57&#41;&#46; More than one hostile behaviour was documented in 46 reports&#46;</p>"
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">PED &#40;n&#8239;&#61;&#8239;57&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Nurse&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">&#60;&#8239;&#46;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Other&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  " align="left" valign="\n
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                  \t\t\t\t">9 &#40;15&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">8 &#40;8&#46;4&#37;&#41;&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">14 &#40;26&#46;4&#37;&#41;&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">Relative&#47;accompanying person&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">44 &#40;77&#46;2&#37;&#41;&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">49 &#40;51&#46;6&#37;&#41;&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">37 &#40;69&#46;8&#37;&#41;&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">&#46;03&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 rowgroup " rowspan="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">Mild verbal&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">5 &#40;8&#46;8&#37;&#41;&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  " align="left" valign="\n
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                  \t\t\t\t">22 &#40;23&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \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">&#60;&#8239;&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Verbal-gestures&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">43 &#40;75&#46;4&#37;&#41;&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">32 &#40;33&#46;7&#37;&#41;&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">15 &#40;28&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Mild physical&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;15&#46;8&#37;&#41;&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">41 &#40;43&#46;2&#37;&#41;&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">15 &#40;28&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead rowgroup " rowspan="5" align="left" valign="\n
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                  \t\t\t\t">&#91;4&#44;0&#93;Reason</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">Waiting time&nbsp;\t\t\t\t\t\t\n
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Scientific Letter
Violence against healthcare workers in a high complexity pediatric center
Conductas hostiles de los usuarios hacia el personal sanitario de urgencias en un centro pediátrico de alta complejidad
Joan Valls Ramon-Cortésa, Clàudia Casas Cascantea, Inés Dalmau Ponsb,c, Victoria Trenchs Sainz de la Mazaa,d, Carles Luaces Cubellsa,d, Cristina Parra Cotandaa,d,
Corresponding author
cristina.parrac@sjd.es

Corresponding author.
a Servicio de Urgencias Pediátricas, Hospital Sant Joan de Déu de Barcelona, Esplugues de Llobregat, Barcelona, Spain
b Servicio de Prevención, Hospital Sant Joan de Déu de Barcelona, Esplugues de Llobregat, Barcelona, Spain
c Comité de Incidentes Violentos al Profesional CIVAP, Hospital Sant Joan de Déu de Barcelona, Esplugues de Llobregat, Barcelona, Spain
d Línea de investigación: «Influencia del entorno en el bienestar del niño y del adolescente». Institut de Recerca de Hospital Sant Joan de Déu (IR-HSJD), Esplugues de Llobregat, Barcelona, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">In our society&#44; workplace violence is an alarming phenomenon&#58; according to the latest report on aggressions to health care professionals in the national health system of Spain &#40;2022&#41;&#44; there were 20 reported attacks per 1000 professionals&#46; Such violence is frequently considered &#8220;inevitable&#8221; and &#8220;part of the job&#8221;&#44; and emergency care and psychiatric care settings are the ones where the rate of aggression is highest&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Any hostile behaviour &#40;HB&#41; can cause&#44; in addition to physical injuries&#44; psychological harm&#44; so it is important to study and prevent any type of attack&#44; as recommended by various professional boards&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">To date&#44; few studies have been conducted on the aggressions experienced by health care workers in paediatric emergency departments &#40;PEDs&#41;&#46; Consequently&#44; we designed a study with the following objectives&#58; &#40;1&#41; to describe HBs in the PED of a children&#8217;s hospital and &#40;2&#41; to determine whether there were significant differences compared to other care settings in the same hospital&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">We conducted a single centre retrospective observational and descriptive study in a tertiary care children&#8217;s hospital serving medically complex patients&#46; In our hospital&#44; health care staff report experienced HBs on a voluntary basis through an electronic record system&#46; The following variables are documented in these reports&#58; care setting &#40;emergency care&#44; inpatient care&#44; outpatient clinics&#44; other&#41;&#44; professional category&#44; characteristics of the attack &#40;mild verbal&#44; verbal with gestures&#44; mild physical and property damage&#41;&#44; attacker&#44; reason for attack&#44; measures taken and impact on the health care worker&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The study included every recorded report &#40;after anonymization&#41; filed between September 2020 and September 2022&#46; The study was approved by the Research Ethics Committee of the hospital &#40;PIC-162-22&#41;&#46; The results were analysed with the statistical software SPSS version 25 for Windows &#40;IBM Corp&#46;&#44; Armonk&#44; NY&#44; USA&#41;&#46; In the descriptive analysis&#44; we summarised the data using the median and interquartile range &#40;quantitative variables&#41; or the frequency and percentage distribution &#40;categorical variables&#41;&#46; We used tests to analyse the distribution of the data&#44; to compare qualitative data &#40;&#967;<span class="elsevierStyleSup">2</span>&#44; contingency table&#44; Fisher exact test&#41;&#46; We considered <span class="elsevierStyleItalic">P</span> values of less than 0&#46;05 statistically significant&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">During the study period&#44; the health care staff of the hospital reported 205 attacks&#46; Fifty-seven HBs &#40;27&#46;8&#37;&#41; took place in the PED&#44; 95 &#40;46&#46;3&#37;&#41; in inpatient wards&#44; 33 &#40;16&#46;3&#37;&#41; in outpatient clinics and 20 &#40;9&#46;6&#37;&#41; in other settings &#40;gynaecology-obstetrics&#44; street&#41;&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Of the 57 HBs reported in the PED&#44; 38 were reported by nursing staff&#44; 11 by doctors and 8 by administrative staff&#46; The distribution by type of HB was 5 mild verbal attacks&#44; 43 verbal attacks accompanied by gestures and 9 mild physical attacks&#59; all the reported mild physical attacks took place in the context of restraining a patient&#46; The aggressor was a relative&#47;accompanying person in 44 cases and the patient in 13&#46; The reasons that triggered the HB as reported by staff were waiting times &#40;15&#41;&#44; disagreement with the rules &#40;12&#41;&#44; agitation &#40;12&#41;&#44; disagreement with care plan &#40;9&#41; and worry &#40;9&#41;&#46; <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a> presents the frequency distribution of the different types of reported HBs&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">The measures taken were verbal de-escalation &#40;57&#41;&#44; physical restraining &#40;10&#41;&#44; contacting security personnel &#40;12&#41;&#44; contacting the point person &#40;5&#41; and contacting the police &#40;4&#41;&#46; Eighteen professionals reported having psychological sequelae and 8 physical sequelae&#46; The psychological sequelae reported by the staff were discomfort &#40;9&#41;&#44; anxiety &#40;9&#41;&#44; worry &#40;3&#41;&#44; sadness &#40;2&#41; and fear &#40;2&#41;&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">When we compared the HBs described at the PED with those described in other hospital settings &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#44; we found statistically significant differences in terms of the professional category of the subject of attack&#44; the aggressor&#44; the type of HB and the trigger&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">Thus&#44; most HBs in the PED were verbal attacks with gestures on the part of relatives and&#47;or accompanying adults and the most frequent reasons were the wait times and disagreement with the rules of the department&#46; These results were consistent with other studies conducted in the adult emergency care setting&#44; although in this setting it is usually the patient who attacks the staff&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> In addition&#44; and also in agreement with the previous literature&#44; most HBs targeted nursing staff&#44; probably due to the closer and longer contact of nurses with patients&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">More aggressions were reported in inpatient care wards than in the PED&#44; although the frequency of attacks in the PED may have been underreported due to the substantial workloads or a shorter contact with families&#46; Furthermore&#44; in inpatient care&#44; physical attacks were more frequent and the proportion of HBs perpetrated by the patients was also greater&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Last of all&#44; nearly one third of the staff that had experienced an attack reported having some form of psychological sequelae&#44; although other authors have reported the presence of psychological disturbances in more than half of attacked professionals&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;5</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">In light of the above&#44; further research is required to create awareness and monitor the issue of aggression against health care workers&#46; In addition&#44; agencies and institutions must develop strategies at the local and regional level to prevent this form of violence&#44; manage these behaviours as they happen and follow-up with the staff to minimise their potential sequelae&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Webpage for data consultation</span><p id="par0065" class="elsevierStylePara elsevierViewall">Informe de Agresiones a profesionales del Sistema Nacional de Salud 2022 &#91;accessed 25 April 2024&#93;&#46; Available at&#58; <a href="https://www.sanidad.gob.es/areas/profesionesSanitarias/agresiones/docs/Informe_Agresiones.2022.pdf">https&#58;&#47;&#47;www&#46;sanidad&#46;gob&#46;es&#47;areas&#47;profesionesSanitarias&#47;agresiones&#47;docs&#47;Informe&#95;Agresiones&#46;2022&#46;pdf</a>&#46;</p></span></span>"
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                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">PED &#40;n&#8239;&#61;&#8239;57&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Inpatient ward &#40;n&#8239;&#61;&#8239;95&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Outpatient clinic &#40;n&#8239;&#61;&#8239;53&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">P</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead rowgroup " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#91;2&#44;0&#93;Professional category</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">Nurse&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">37 &#40;64&#46;9&#37;&#41;&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">77 &#40;81&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24 &#40;45&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;&#8239;&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Doctor&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">11 &#40;19&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 &#40;10&#46;5&#37;&#41;&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">15 &#40;28&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Other&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;15&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;8&#46;4&#37;&#41;&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">14 &#40;26&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Aggressor&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">Relative&#47;accompanying person&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">44 &#40;77&#46;2&#37;&#41;&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">49 &#40;51&#46;6&#37;&#41;&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">37 &#40;69&#46;8&#37;&#41;&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">&#46;03&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 rowgroup " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#91;2&#44;0&#93;Type of attack</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">Mild verbal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;8&#46;8&#37;&#41;&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">22 &#40;23&#46;2&#37;&#41;&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">23 &#40;43&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;&#8239;&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Verbal-gestures&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">43 &#40;75&#46;4&#37;&#41;&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">32 &#40;33&#46;7&#37;&#41;&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">15 &#40;28&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mild physical&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;15&#46;8&#37;&#41;&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">41 &#40;43&#46;2&#37;&#41;&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">15 &#40;28&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead rowgroup " rowspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#91;4&#44;0&#93;Reason</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">Waiting time&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">15 &#40;26&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;2&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;13&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;&#8239;&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Disagreement with rules&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 &#40;21&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20 &#40;21&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;17&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Agitation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 &#40;21&#46;1&#37;&#41;&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">29 &#40;30&#46;5&#37;&#41;&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">40 &#40;7&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Disagreement with medical plan&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;15&#46;8&#37;&#41;&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">25 &#40;26&#46;3&#37;&#41;&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">19 &#40;35&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Worry&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;15&#46;8&#37;&#41;&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">19 &#40;20&#46;0&#37;&#41;&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">14 &#40;26&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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ISSN: 23412879
Original language: English
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Idiomas
Anales de Pediatría (English Edition)