Original article
Pressure ulcers in patients hospitalized in internal medicine: Associated factors and mortality
Úlceras por presión en pacientes ingresados en Medicina Interna: factores asociados y mortalidad
Read
24
Timeswas read the article
11
Total PDF
13
Total HTML
Share statistics
array:23 [ "pii" => "S2254887416300613" "issn" => "22548874" "doi" => "10.1016/j.rceng.2016.07.002" "estado" => "S300" "fechaPublicacion" => "2016-12-01" "aid" => "1299" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI)" "copyrightAnyo" => "2016" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Rev Clin Esp. 2016;216:461-7" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 5 "formatos" => array:2 [ "HTML" => 1 "PDF" => 4 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0014256516301242" "issn" => "00142565" "doi" => "10.1016/j.rce.2016.07.003" "estado" => "S300" "fechaPublicacion" => "2016-12-01" "aid" => "1299" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI)" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Rev Clin Esp. 2016;216:461-7" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 109 "formatos" => array:2 [ "HTML" => 65 "PDF" => 44 ] ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">ORIGINAL</span>" "titulo" => "Úlceras por presión en pacientes ingresados en Medicina Interna: factores asociados y mortalidad" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "461" "paginaFinal" => "467" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Pressure ulcers in patients hospitalized in Internal Medicine: associated factors and mortality" ] ] "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" => 1102 "Ancho" => 1502 "Tamanyo" => 102771 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Diagrama del proceso de selección de pacientes.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J. Díez-Manglano, C. Fernández-Jiménez, M.P. Lambán-Aranda, M.C. Landa-Santesteban, S. Isasi de Isasmendi-Pérez, P. Moreno-García, E. Bejarano-Tello, J. Barranco-Usón, E. Munilla-López, E. del Corral-Beamonte" "autores" => array:11 [ 0 => array:2 [ "nombre" => "J." "apellidos" => "Díez-Manglano" ] 1 => array:2 [ "nombre" => "C." "apellidos" => "Fernández-Jiménez" ] 2 => array:2 [ "nombre" => "M.P." "apellidos" => "Lambán-Aranda" ] 3 => array:2 [ "nombre" => "M.C." "apellidos" => "Landa-Santesteban" ] 4 => array:2 [ "nombre" => "S." "apellidos" => "Isasi de Isasmendi-Pérez" ] 5 => array:2 [ "nombre" => "P." "apellidos" => "Moreno-García" ] 6 => array:2 [ "nombre" => "E." "apellidos" => "Bejarano-Tello" ] 7 => array:2 [ "nombre" => "J." "apellidos" => "Barranco-Usón" ] 8 => array:2 [ "nombre" => "E." "apellidos" => "Munilla-López" ] 9 => array:2 [ "nombre" => "E." "apellidos" => "del Corral-Beamonte" ] 10 => array:1 [ "colaborador" => "los investigadores del estudio IMPIMI" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2254887416300613" "doi" => "10.1016/j.rceng.2016.07.002" "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/S2254887416300613?idApp=WRCEE" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0014256516301242?idApp=WRCEE" "url" => "/00142565/0000021600000009/v1_201611291255/S0014256516301242/v1_201611291255/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2254887416300601" "issn" => "22548874" "doi" => "10.1016/j.rceng.2016.07.001" "estado" => "S300" "fechaPublicacion" => "2016-12-01" "aid" => "1301" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI)" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Rev Clin Esp. 2016;216:468-73" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 3 "formatos" => array:2 [ "HTML" => 1 "PDF" => 2 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Clinical and financial implications of disease-related malnutrition in a department of Internal Medicine: Prospective cohort study" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "468" "paginaFinal" => "473" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Repercusiones clínicas y económicas de la desnutrición relacionada con la enfermedad en un servicio de Medicina Interna: estudio de cohortes prospectivas" ] ] "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" => 1307 "Ancho" => 2500 "Tamanyo" => 122688 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Results of the nutritional screening at admission and in the subgroup without malnutrition during hospitalization.</p> <p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Abbreviation: MUST; Malnutrition Universal Screening Tool.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M.D. Ballesteros-Pomar, A. Calleja-Fernández, M. González-Valdés, B. Pintor-de la Maza, R. Villar Taibo, A. Vidal-Casariego, A. Urioste-Fondo, B. Torres-Torres, D. de Luis-Román, I. Cano-Rodríguez" "autores" => array:10 [ 0 => array:2 [ "nombre" => "M.D." "apellidos" => "Ballesteros-Pomar" ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Calleja-Fernández" ] 2 => array:2 [ "nombre" => "M." "apellidos" => "González-Valdés" ] 3 => array:2 [ "nombre" => "B." "apellidos" => "Pintor-de la Maza" ] 4 => array:2 [ "nombre" => "R." "apellidos" => "Villar Taibo" ] 5 => array:2 [ "nombre" => "A." "apellidos" => "Vidal-Casariego" ] 6 => array:2 [ "nombre" => "A." "apellidos" => "Urioste-Fondo" ] 7 => array:2 [ "nombre" => "B." "apellidos" => "Torres-Torres" ] 8 => array:2 [ "nombre" => "D." "apellidos" => "de Luis-Román" ] 9 => array:2 [ "nombre" => "I." "apellidos" => "Cano-Rodríguez" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0014256516301266" "doi" => "10.1016/j.rce.2016.07.005" "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/S0014256516301266?idApp=WRCEE" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887416300601?idApp=WRCEE" "url" => "/22548874/0000021600000009/v1_201611291252/S2254887416300601/v1_201611291252/en/main.assets" ] "en" => array:21 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Pressure ulcers in patients hospitalized in internal medicine: Associated factors and mortality" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "461" "paginaFinal" => "467" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "J. Díez-Manglano, C. Fernández-Jiménez, M.P. Lambán-Aranda, M.C. Landa-Santesteban, S. Isasi de Isasmendi-Pérez, P. Moreno-García, E. Bejarano-Tello, J. Barranco-Usón, E. Munilla-López, E. del Corral-Beamonte" "autores" => array:11 [ 0 => array:4 [ "nombre" => "J." "apellidos" => "Díez-Manglano" "email" => array:1 [ 0 => "jdiez@aragon.es" ] "referencia" => array:4 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] 3 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "C." "apellidos" => "Fernández-Jiménez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "M.P." "apellidos" => "Lambán-Aranda" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "M.C." "apellidos" => "Landa-Santesteban" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "S." "apellidos" => "Isasi de Isasmendi-Pérez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 5 => array:3 [ "nombre" => "P." "apellidos" => "Moreno-García" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 6 => array:3 [ "nombre" => "E." "apellidos" => "Bejarano-Tello" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 7 => array:3 [ "nombre" => "J." "apellidos" => "Barranco-Usón" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 8 => array:3 [ "nombre" => "E." "apellidos" => "Munilla-López" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 9 => array:3 [ "nombre" => "E." "apellidos" => "del Corral-Beamonte" "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 10 => array:2 [ "colaborador" => "IMPIMI researchers study" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">◊</span>" "identificador" => "fn0010" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Medicina Interna, Hospital Royo Villanova, Zaragoza, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Grupo de Investigación en Comorbilidad y Pluripatología de Aragón, Instituto Aragonés de Ciencias de la Salud, Zaragoza, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Departamento de Medicina, Dermatología y Psiquiatría, Universidad de Zaragoza, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Úlceras por presión en pacientes ingresados en Medicina Interna: factores asociados y mortalidad" ] ] "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" => 1585 "Ancho" => 1592 "Tamanyo" => 83041 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Cumulative survival curves (Kaplan–Meier) according to the presence or absence of pressure ulcers. Abbreviation: PU, pressure ulcers.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Background</span><p id="par0005" class="elsevierStylePara elsevierViewall">The aging of the population is reflected in the patients treated in the departments of internal medicine.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">1</span></a> In one study, the mean age of patients hospitalized in departments of internal medicine was 79.9 years and has increased between 8 and 19 years in the last 20 years.<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">2</span></a> An increase has also been observed in the patients’ disability.<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Elderly patients with disability frequently experience pressure ulcers as the result of concomitant diseases, immobility and, on occasion, deficient nutrition.<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">4–6</span></a> Over the last 15 years in Spain, several epidemiological surveys have been conducted on pressure ulcers, and the prevalence in hospitalized patients remains approximately 8%.<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">7–9</span></a> Sixty percent of pressure ulcers observed in hospitalized patients develop in the hospital, and a third of these are in advanced stages (<span class="elsevierStyleSmallCaps">III</span> or <span class="elsevierStyleSmallCaps">IV</span>).<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">9</span></a> In 2013, the prevalence of pressure ulcers was 7.41% in the Spanish medical departments.<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">9</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Pressure ulcers can become infected and complicated easily, with bleeding, necrosis and pain appearing and requiring prolonged care. Pressure ulcers are considered a factor of poor prognosis for hospitalized patients and are associated with increased mortality, both if the patient presents them on admission and when they are acquired during hospitalization.<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">10–12</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The aim of this study was to determine the prevalence of pressure ulcers in patients hospitalized in internal medicine departments, the factors associated with their presence and their influence on short, medium and long-term mortality.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Patients and methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Design</span><p id="par0025" class="elsevierStylePara elsevierViewall">The Minimal Intervention in Patients Hospitalized in Internal Medicine (IMPIMI) study<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">13,14</span></a> (<a class="elsevierStyleCrossRef" href="#sec0060">Appendix</a>) is an intervention study with 2 parallel groups designed to reduce the duration of urinary tract catheterization and intravenous fluid treatment. The intervention was applied to 1 of 2 groups. Twice a week during the meeting of the therapeutic team of physicians and nurses, an assessment was conducted on withdrawing the bladder catheters, finalizing the intravenous fluid treatment, the onset of pressure ulcers and the early detection of delirium.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Procedures</span><p id="par0030" class="elsevierStylePara elsevierViewall">The study included all unselected patients hospitalized in the department of internal medicine during the months of October 2010, January 2011, May 2011 and October 2011. On admission, a nurse interviewed each patient, their relatives or companions to assess the patient's functional state and risk of pressure ulcers. After the discharge, the medical history data and data from the administrative database on hospital discharges were extracted. The following information was collected from each patient: age, sex, residence (home or assisted living), ability to perform basic activities of daily life, risk of presenting pressure ulcers, onset of delirium during hospitalization, presence of pressure ulcers, use during hospitalization of urinary catheter, intravenous fluid therapy, placement of nasogastric catheter or percutaneous gastrostomy, major diagnostic category at discharge, duration of the hospitalization and mean weight of the diagnosis-related group (DRG). The ability to perform the basic activities of daily life was assessed with the Barthel index, which includes 10 tasks: feeding, bathing, dressing, grooming, voiding, defecation, going to the toilet, transferring, walking and climbing up and down stairs.<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">15</span></a> The range of scores is 0 to 100; the higher the score, the greater the individual's capacity. Thus, 0 corresponds to absolute dependence and 100 represents total autonomy for basic activities of daily life. The Barthel index prior to admission in the stable phase was recorded. The risk of presenting pressure ulcers was assessed with the Norton scale, which records 5 parameters: physical state, mental state, activity, movement and incontinence.<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">16</span></a> The scale ranges from 5 to 20; the lower the score, the greater the risk of pressure ulcers. The presence of pressure ulcers was assessed at admission and every day during the hospitalization. The severity of the pressure ulcers was graduated from <span class="elsevierStyleSmallCaps">I</span> to IV,<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">17</span></a> and the highest degree pressure ulcer was recorded when there were more than one. We also recorded whether the patient presented pressure ulcers at the time of discharge.</p><p id="par0035" class="elsevierStylePara elsevierViewall">A 3-year follow-up was subsequently conducted by reviewing the medical history, by telephone or by consulting the National Death Index.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The study was approved by the Clinical Research Ethics Committee of Aragon (PI 12/0009), and the patients or their relatives provided their consent for inclusion in the study.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Statistical analysis</span><p id="par0045" class="elsevierStylePara elsevierViewall">The qualitative and quantitative variables are presented as absolute frequencies (percentages), and means (standard deviation), respectively. The comparison of qualitative variables was conducted with the chi-squared test. The Kolmogorov–Smirnov test was employed to verify that the quantitative variables did not follow a normal distribution. The quantitative variables were compared with the Mann–Whitney <span class="elsevierStyleItalic">U</span> test.</p><p id="par0050" class="elsevierStylePara elsevierViewall">To assess the association of each variable with the presence of pressure ulcers, we constructed a multivariate logistic regression model that included those variables with a <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.1 in the univariate model. To study the association of the variables with mortality, we performed a Cox proportional regression and Kaplan–Meier survival curves with the log-rank test. In all cases, the level of statistical significance was <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.05. The statistical analysis was conducted with the SPSS statistical package, version 22.0.</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Results</span><p id="par0055" class="elsevierStylePara elsevierViewall">We included 699 patients with a mean age of 74.6 (15.2) years. <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a> shows the patient selection diagram. Pressure ulcers occurred in 100 (14.3%) patients, 27 of whom had grade <span class="elsevierStyleSmallCaps">1</span>, 17 had grade <span class="elsevierStyleSmallCaps">2</span>, 21 had grade <span class="elsevierStyleSmallCaps">3</span> and 25 had grade <span class="elsevierStyleSmallCaps">4</span>; this datum was not available for 10 patients. In 69 cases, the pressure ulcers started at home, 25 cases occurred during hospitalization and 3 cases occurred in both circumstances. At discharge, the pressure ulcers were in the process of healing in 86 patients.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Factors associated with the presence of pressure ulcers</span><p id="par0060" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the characteristics of patients with and without pressure ulcers. The patients with pressure ulcers were older, mostly women, resided in assisted living and had greater disability in basic activities of daily life. The patients with pressure ulcers had a greater frequency of infectious diseases and delirium and fewer hepatic, biliary and pancreatic diseases. The placement of a vesical catheter, nasogastric catheter, percutaneous gastrostomy and intravenous fluid treatment were more common in the patients with pressure ulcers.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">The multivariate analysis showed that the Barthel index and Norton scale were independently associated with the presence of pressure ulcers (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Mean hospital stay and expenditure</span><p id="par0070" class="elsevierStylePara elsevierViewall">The patients with pressure ulcers had longer mean stays (13.1 [8.4] days vs. 9 [7.4]; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.001). The weight of the DRG, which estimates the hospitalization expenses, was 2.10 (0.96) for the patients with pressure ulcers and 1.58 (0.96) for those without pressure ulcers (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.001).</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Mortality</span><p id="par0075" class="elsevierStylePara elsevierViewall">Eighty-two patients died during hospitalization. The mortality was greater for the patients with pressure ulcers (23% vs. 9.8%; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.001). At 3 years, 333 (47.6%) patients had died, with a much greater mortality among the patients with pressure ulcers (83% vs. 41.7%; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.001) (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). Of these, 23% died during the hospitalization, 56% at 6 months and 68% during the first year. There were no differences in mortality during the hospitalization or at the end of the follow-up among the patients with differing degrees of pressure ulcer severity.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">The multivariate analysis showed that age, nervous system diseases, delirium, the Barthel index and pressure ulcers were independently associated with mortality (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>). The pressure ulcers present at admission (HR, 3.069; 95% CI 2.326–4.048; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.001) and those that developed during hospitalization were associated with mortality (HR, 2.340; 95% CI 1.531–3.576; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.001).</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Discussion</span><p id="par0085" class="elsevierStylePara elsevierViewall">The main findings of this study were that approximately 1 of every 7 patients hospitalized in internal medicine has pressure ulcers at admission or during hospitalization and that patients with pressure ulcers have a high mortality in the short, mean and long-term.</p><p id="par0090" class="elsevierStylePara elsevierViewall">Despite the improvements in treating pressure ulcers and the use of various strategies to prevent their onset in hospitalized patients, the prevalence of pressure ulcers remains constant in the 3 national surveys conducted in Spain.<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">7–9</span></a> The same phenomenon has been observed in studies conducted in acute care tertiary hospitals.<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">6</span></a> Age and the admitting department have been associated with pressure ulcers, which are more common in medical departments than in surgical ones.<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">6</span></a> The prevalence has varied between 6.3% and 8.6% in the collection of medical departments of acute care hospitals.<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">15,16</span></a> We observed a prevalence of 14.3%, which was higher than previously reported and possibly due to the fact that the study was performed exclusively in a department of internal medicine, whose patients are usually older than those of other medical departments, with the exception of geriatric medicine units. In fact, in the study by Tomás-Life et al.,<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">18</span></a> conducted in the medical departments of the Balearic Islands, the prevalence of pressure ulcers in the age group older than 70 years was 11.4%, which is closer to the rate observed in our study. It is known that mild pressure ulcers occasionally go unnoticed and are not recorded in the medical records.<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">19</span></a> A meta-analysis found that the exclusive clinical judgment of the nursing staff was insufficient for detecting pressure ulcers and that the judgment needed to be combined with the use of a validated scale.<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">20</span></a> Our study falls within a prospective program targeted at the early detection of pressure ulcers using the Norton scale. We therefore expect that the physicians and nurses are more sensitized to detecting and recording pressure ulcers, with a more comprehensive patient assessment, as recommended by the clinical practice guidelines.<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">21,22</span></a> This could justify the higher prevalence we observed.</p><p id="par0095" class="elsevierStylePara elsevierViewall">There are various scales for assessing the risk of presenting a pressure ulcer. We employed the Norton scale, which has one of highest predictive capacities.<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">20</span></a> One of the items on this scale is the patient's mobility. Length of stay, presence of coma, carrying a urinary catheter or nasogastric catheter and undergoing intravenous fluid treatment are factors that have been associated with the onset of pressure ulcers.<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">1,6,23</span></a> All of these factors are related to immobility. In the univariate analysis, carrying a urinary or nasogastric catheter or percutaneous gastrostomy and the intravenous administration of fluids were associated with the presence of pressure ulcers. It is difficult to establish the causality because this type of catheter is also placed in patients with pressure ulcers to administer drugs, nutrition and to avoid contaminating the pressure ulcers with urine. However, we believe that all strategies directed toward decreasing the duration of catheterization in patients who do not have pressure ulcers can help prevent their onset. Delirium was more common in the patients with pressure ulcers and can sometimes result in restricted movement with the use of hospital beds with guardrails and even restraints. However, only the Norton scale and disability measured by the Barthel index were factors independently associated with pressure ulcers.</p><p id="par0100" class="elsevierStylePara elsevierViewall">Another of this study's findings was that the hospital stay of patients with pressure ulcers was extended by 4 days. In a study with more than 5 million discharges from departments of internal medicine in Spain, pressure ulcers were 10 times more common in patients with a hospital stay longer than 30 days.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">1</span></a> A study conducted in 2007 estimated that the cost of treating pressure ulcers in Spain was 461 million euros and that 45% of this expenditure was due to prolonged hospital stays.<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">24</span></a> In our study, the weight of the DRG was 0.52 higher in the cases with pressure ulcers, which corresponded to an additional expenditure of € 2435.94 according to data from the Ministry of Health.<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">25</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">Almost half of the patients had died after the 3 years of follow-up. This is a high mortality rate, which could be explained by the patients’ mean age and their complexity. This complexity was manifested in a high degree of disability and the high weight of the DRG. Pressure ulcers have been associated with increased mortality. In our series, one of every 4 patients with pressure ulcers died during hospitalization. Two of every 3 had died by the end of a year and more than 8 of every 10 had died by the end of 3 years. We can therefore consider pressure ulcers as a factor of poor prognosis in the short, medium and long term. Previous studies have already confirmed this association with mortality.<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">10,26</span></a> Recently, pressure ulcers have been included in an index to establish the prognosis at 6 months in patients with chronic diseases in advanced phases.<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">27</span></a> Given these findings, we consider that when a patient presents pressure ulcers we must start planning the start of palliative care, especially if the patient is elderly, dependent or has delirium or a nervous system disorder.</p><p id="par0110" class="elsevierStylePara elsevierViewall">We know of no other study published in Spain on the prevalence of pressure ulcers in a department of internal medicine. This is one of the strengths of our study, along with the extended patient follow-up. However, our study also has a number of limitations. Firstly, the study was conducted in a single hospital; multicenter studies are known to provide evidence with greater rigor. This fact could decrease the extrapolation of the results to other settings. Secondly, the study was conducted within the framework of a specific project for monitoring the onset of pressure ulcers, and its results on prevalence could be different from those outside this research context. However, this is also a strength because the results reflect data from the real world, which in other circumstances could go unnoticed. It is a fact that physicians occasionally ignore the presence of pressure ulcers in their patients, especially when the pressure ulcers are low-grade, delegating their surveillance and care to the nursing staff despite the prognostic importance of pressure ulcers.</p><p id="par0115" class="elsevierStylePara elsevierViewall">In summary, pressure ulcers are very common in patients hospitalized in internal medicine and are associated with a poor prognosis. Their assessment is therefore essential for establishing the short, medium and long-term therapeutic objectives.</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Conflict of interests</span><p id="par0120" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres763831" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Patients and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec765204" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres763830" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Pacientes y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec765205" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Background" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Patients and methods" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Design" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Procedures" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Statistical analysis" ] ] ] 6 => array:3 [ "identificador" => "sec0030" "titulo" => "Results" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0035" "titulo" => "Factors associated with the presence of pressure ulcers" ] 1 => array:2 [ "identificador" => "sec0040" "titulo" => "Mean hospital stay and expenditure" ] 2 => array:2 [ "identificador" => "sec0045" "titulo" => "Mortality" ] ] ] 7 => array:2 [ "identificador" => "sec0050" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0055" "titulo" => "Conflict of interests" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2016-03-31" "fechaAceptado" => "2016-07-19" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec765204" "palabras" => array:3 [ 0 => "Pressure ulcers" 1 => "Mortality" 2 => "Internal medicine" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec765205" "palabras" => array:3 [ 0 => "Úlceras por presión" 1 => "Mortalidad" 2 => "Medicina Interna" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To determine the prevalence of pressure ulcers in patients hospitalized in internal medicine and the clinical factors and risk of death associated with its presence.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Patients and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Prospective cohort study with patients hospitalized in internal medicine. We recorded the age, sex, presence of pressure ulcers, degree of ulceration, Barthel index, Norton scale, major diagnostic category, length of hospital stay and weight of the diagnosis-related groups. We compared the clinical characteristics of the patients with or without ulcers and analyzed the mortality after 3 years based on the presence of ulcers.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The study included 699 patients, 100 of whom (14.3%) had pressure ulcers (27 with grade I, 17 with grade II, 21 with grade III, 25 with grade IV and 10 with unknown grade). The Barthel index (OR 0.985; 95% CI 0.972–0.998; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.022) and Norton scale (OR 0.873; 95% CI 0.780–0.997; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.018) are independently associated with ulcers. Twenty-three percent of the patients with ulcers died during hospitalization, 68% died within a year, and 83% died within 3 years. The presence of pressure ulcers was independently associated with mortality (HR, 1.531; 95% CI 1.140–2.056; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.005).</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Pressure ulcers are common in patients hospitalized in internal medicine, and their presence is associated with higher short, medium and long-term mortality.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Patients and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Determinar la prevalencia de las úlceras por presión en pacientes hospitalizados en Medicina Interna y los factores clínicos y riesgo de muerte asociados a su presencia.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Pacientes y métodos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio prospectivo de cohortes con pacientes ingresados en Medicina Interna. Se recogieron la edad, sexo, presencia de úlceras por presión, grado de la úlcera, índice de Barthel, escala de Norton, categoría diagnóstica mayor, duración de la estancia hospitalaria y peso del grupo relacionado de diagnóstico. Se compararon las características clínicas de los pacientes con o sin úlceras y se analizó la mortalidad al cabo de 3 años en función de la presencia de úlceras.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron 699 pacientes, de los que 100 (14,3%) presentaron úlceras por presión (27 de grado <span class="elsevierStyleSmallCaps">I</span>, 17 de grado <span class="elsevierStyleSmallCaps">II</span>, 21 de grado <span class="elsevierStyleSmallCaps">III</span>, 25 de grado <span class="elsevierStyleSmallCaps">IV</span> y 10 de grado no conocido). El índice de Barthel (OR 0,985 IC95% 0,972-0,998; p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,022) y la escala de Norton (OR 0,873 IC95% 0,780–0,997; p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,018) se asociaron de forma independiente con las úlceras. Durante el ingreso fallecieron el 23% de los pacientes con úlceras, al cabo de un año el 68% y a los 3 años el 83%. La presencia de úlceras por presión se asoció de forma independiente con la mortalidad (HR 1,531, IC95% 1,140–2,056, p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,005).</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Las úlceras por presión son frecuentes en los pacientes hospitalizados en Medicina Interna y su presencia se asocia con mayor mortalidad a corto, medio y largo plazo.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Pacientes y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:3 [ 0 => array:3 [ "etiqueta" => "◊" "nota" => "<p class="elsevierStyleNotepara" id="npar0025">More information about IMPIMI researchers study is available in <a class="elsevierStyleCrossRef" href="#sec0060">Appendix</a>.</p>" "identificador" => "fn0010" ] 1 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0020">Please cite this article as: Díez-Manglano J, Fernández-Jiménez C, Lambán-Aranda MP, Landa-Santesteban MC, Isasi de Isasmendi-Pérez S, Moreno-García P, et al. Úlceras por presión en pacientes ingresados en Medicina Interna: factores asociados y mortalidad. Rev Clin Esp. 2016;216:461–467.</p>" ] 2 => array:3 [ "etiqueta" => "*" "nota" => "<p class="elsevierStyleNotepara" id="npar0030">Department of Internal Medicine, Hospital Royo Villanova, Zaragoza, Spain.</p>" "identificador" => "fn0005" ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "<p id="par0125" class="elsevierStylePara elsevierViewall">Jesús Díez-Manglano, Patricia Al-Cheikh-Felices, Susana Alcubierre-Iriarte, María Jesús Arnal-Longares, Julia Barranco-Usón, Esperanza Bejarano Tello, María Pilar Carreño-Borrego, Esther del Corral-Beamonte, Fabiola Díez-Massó, Cristina Fernández-Jiménez, Juan Carlos Ferrando-Vela, Vanesa Garcés-Horna, Francisco Javier Gomes-Martín, María Soledad Isasi de Isasmendi-Pérez, María Pilar Lambán-Aranda, María Cristina Landa-Santesteban, Rosa María Martínez-Álvarez, Pablo Martínez-Rodés, María Pilar Moreno-García, Eulalia Munilla López, Claudia Palazón-Fraile, María Jesús Pardo-Díez, Pilar Pueyo-Tejedor, Santiago Alfonso Rubio-Félix, Rogelio Serrano-Lázaro, María Sevil-Puras, Sofía Terrén-Portolés, Carla Toyas-Miazza.</p>" "etiqueta" => "Appendix" "titulo" => "List of researchers of the IMPIMI study<a class="elsevierStyleCrossRef" href="#fn0005"><span class="elsevierStyleSup">*</span></a><span class="elsevierStyleFootnote" id="fn0005"><span class="elsevierStyleLabel">*</span><p class="elsevierStyleNotepara" id="npar0030">Department of Internal Medicine, Hospital Royo Villanova, Zaragoza, Spain.</p></span>" "identificador" => "sec0060" ] ] ] ] "multimedia" => array:5 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1096 "Ancho" => 1488 "Tamanyo" => 99955 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Diagram of the patient selection process.</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" => 1585 "Ancho" => 1592 "Tamanyo" => 83041 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Cumulative survival curves (Kaplan–Meier) according to the presence or absence of pressure ulcers. Abbreviation: PU, pressure ulcers.</p>" ] ] 2 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Abbreviation</span>: MDC, major diagnostic category at discharge.</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">Variable \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 (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>699) \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">With pressure ulcers (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>100) \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">Without pressure ulcers (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>599) \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">p</span> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Age</span><a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">74.6 (15.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">82.2 (8.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">73.3 (15.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Sex</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">333 (47.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">35 (35.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">298 (49.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.006 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">366 (52.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">65 (65.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">301 (50.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Living in assisted residence</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">158 (22.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">55 (55.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">103 (17.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">MDC</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Nervous system \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">66 (9.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 (6.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">60 (10.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.204 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Respiratory system \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">152 (21.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24 (24.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">128 (21.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.555 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Circulatory system \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">96 (13.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16 (16.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">80 (13.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.477 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Gastrointestinal system \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">126 (18.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 (12.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">114 (19.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.090 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Liver, bile duct and pancreas \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">50 (7.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (1.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">49 (8.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.010 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Kidneys and urinary tract \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">57 (8.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13 (13.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">44 (7.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.056 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Infectious diseases \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">33 (4.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 (9.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24 (4.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.029 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Others \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">119 (17.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19 (19.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">100 (16.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.570 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Barthel index</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">66.2 (38.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">21.8 (30.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">73.4 (34.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Norton scale</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15.0 (4.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9.5 (3.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15.9 (4.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Delirium</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">91 (13.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22 (22.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">69 (1.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">.004 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Urinary catheter</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">247 (35.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">65 (65.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">182 (30.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Intravenous fluids</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">490 (70.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">89 (89.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">401 (66.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Nasogastric tube</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 (2.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 (6.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 (1.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.002 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Percutaneous gastrostomy</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 (0.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (3.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (0.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">.003 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1261792.png" ] ] ] "notaPie" => array:2 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Data from 624 patients.</p> <p class="elsevierStyleNotepara" id="npar0010">The data are presented with <span class="elsevierStyleItalic">n</span> (%) or</p>" ] 1 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "b" "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Mean (standard deviation).</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Characteristics of the included patients.</p>" ] ] 3 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Abbreviations: CI, confidence interval; MDC, major diagnostic category; OR: odds ratio.</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-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Variable \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Univariate analysis</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Multivariate analysis</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \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">OR (95% CI) \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">p</span> \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">OR (95% CI) \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">p</span> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.065 (1.040–1.091) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.020 (0.990–1.052) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.192 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Female sex \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.839 (1.183–2.858) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.007 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.179 (0.668–2.081) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.570 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Living in residence \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.874 (3.755–9.189) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.235 (0.672–2.267) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.497 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">MDC gastrointestinal system \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.580 (0.307–1.097) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.094 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.852 (0.350–2.075) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.725 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">MDC liver/bile duct/pancreas \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.113 (0.015–0.831) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.032 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.298 (0.035–2.507) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.265 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">MDC kidneys/urinary tract \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.885 (0.975–3.642) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.059 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.005 (0.418–2.416) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.990 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">MDC infectious disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.370 (1.068–5.260) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.034 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.676 (0.614–4.573) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.313 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Delirium \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.158 (1.263–3.687) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.822 (0.406–1.664) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.586 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Barthel index \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.963 (0.956–0.970) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.985 (0.972–0.998) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.022 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Norton scale \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.731 (0.687–0.779) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.873 (0.780–0.977) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.018 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Urinary catheter \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.255 (2.723–6.649) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.686 (0.915–3.106) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.094 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Intravenous fluids \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.995 (2.087–7.646) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.603 (0.699–3.677) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.265 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Nasogastric tube \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.715 (1.600–13.894) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.005 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.198 (0.320–4.482) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.789 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Percutaneous gastrostomy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9.232 (1.523–55.963) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.016 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.774 (0.466–48.877) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.188 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1261793.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Factors associated with the presence of pressure ulcers.</p>" ] ] 4 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Abbreviations: CI, confidence interval; HR, hazard ratio; MDC, major diagnostic category.</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">Variable \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">HR (95% CI) \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">p</span> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.028 (1.017–1.040) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">MDC nervous system \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.551 (0.340–0.892) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.015 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Delirium \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.609 (1.210–2.139) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Barthel index \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.990 (0.986–0.994) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pressure ulcers \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.531 (1.140–2.056) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.005 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1261794.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Factors associated with mortality in the multivariate analysis (Cox regression).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:27 [ 0 => array:3 [ "identificador" => "bib0140" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prolonged length of stay in hospitalized internal medicine patients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. Barba" 1 => "J. Marco" 2 => "J. Canora" 3 => "S. Plaza" 4 => "S.N. Juncos" 5 => "J. Hinojosa" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Eur J Intern Med" "fecha" => "2015" "volumen" => "10" "paginaInicial" => "772" "paginaFinal" => "775" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0145" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "La edad de los pacientes atendidos en los servicios de medicina interna en España: una perspectiva de 20 años" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J. Casademont" 1 => "E. Francia" 2 => "O. Torres" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Med Clin (Barc)" "fecha" => "2012" "volumen" => "138" "paginaInicial" => "289" "paginaFinal" => "292" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0150" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Disability impacts length of stay in General Internal Medicine patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "C. Tan" 1 => "T.S. Ng" 2 => "G.C.H. Koh" 3 => "D.A. de Silva" 4 => "A. Earnest" 5 => "S. Barbier" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s11606-014-3032-5" "Revista" => array:6 [ "tituloSerie" => "J Gen Intern Med" "fecha" => "2014" "volumen" => "29" "paginaInicial" => "885" "paginaFinal" => "890" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25355089" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0155" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Incidence of hospital-acquired pressure ulcers – a population-based study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "J.C. Gardiner" 1 => "P.L. Reed" 2 => "J.D. Bonner" 3 => "D.K. Haggerty" 4 => "D.G. Hale" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/iwj.12386" "Revista" => array:2 [ "tituloSerie" => "Int Wound J" "fecha" => "2014" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0160" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Immobility – a major risk factor for development of pressure ulcers among adult hospitalized patients: a prospective study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M. Lindgren" 1 => "M. Unosson" 2 => "M. Fredrikson" 3 => "A.C. Ek" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Scand J Caring Sci" "fecha" => "2004" "volumen" => "18" "paginaInicial" => "57" "paginaFinal" => "64" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15005664" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0165" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Evolución de la prevalencia de úlceras por presión en un hospital de agudos de tercer nivel (2006–2013)" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "C. Alonso-Lorente" 1 => "J.I. Barrasa-Villar" 2 => "C. Aibar-Remón" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.cali.2015.01.011" "Revista" => array:6 [ "tituloSerie" => "Rev Calid Asist" "fecha" => "2016" "volumen" => "30" "paginaInicial" => "135" "paginaFinal" => "141" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25771847" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0170" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "2.° Estudio nacional de prevalencia de úlceras por presión en España, 2005. Epidemiología y variables definitorias de las lesiones y pacientes" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.J. Soldevilla Agreda" 1 => "J.E. Torra i Bou" 2 => "J. Verdú Soriano" 3 => "F. Martínez Cuervo" 4 => "P. López Casanova" 5 => "J. Rueda López" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Gerokomos" "fecha" => "2006" "volumen" => "17" "paginaInicial" => "154" "paginaFinal" => "172" ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0175" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "3.° Estudio nacional de prevalencia de úlceras por presión en España, 2009. Epidemiología y variables definitorias de las lesiones y pacientes" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J.J. Soldevilla Agreda" 1 => "J.E. Torra i Bou" 2 => "J. Verdú Soriano" 3 => "P. López Casanova" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Gerokomos" "fecha" => "2011" "volumen" => "22" "paginaInicial" => "77" "paginaFinal" => "90" ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0180" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Epidemiología de las úlceras por presión en España en 2013: 4° estudio nacional de prevalencia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "P.L. Pancorbo-Hidalgo" 1 => "F.P. García-Fernández" 2 => "J.E. Torra i Bou" 3 => "J. Verdú Soriano" 4 => "J.J. Soldevilla Agreda" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Gerokomos" "fecha" => "2014" "volumen" => "25" "paginaInicial" => "162" "paginaFinal" => "170" ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0185" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mortality and complications in very old patients (90+) admitted to departments of internal medicine in Spain" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. Barba" 1 => "J.M. Martínez" 2 => "A. Zapatero" 3 => "S. Plaza" 4 => "J.E. Losa" 5 => "J. Canora" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ejim.2010.11.001" "Revista" => array:6 [ "tituloSerie" => "Eur J Intern Med" "fecha" => "2011" "volumen" => "22" "paginaInicial" => "49" "paginaFinal" => "52" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21238893" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0190" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hospital-acquired pressure ulcers: results from the national Medicare Patient Safety Monitoring System study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C.H. Lyder" 1 => "Y. Wang" 2 => "M. Metersky" 3 => "M. Curry" 4 => "R. Kliman" 5 => "N.R. Verzier" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1532-5415.2012.04106.x" "Revista" => array:6 [ "tituloSerie" => "J Am Geriatr Soc" "fecha" => "2012" "volumen" => "60" "paginaInicial" => "1603" "paginaFinal" => "1608" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22985136" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0195" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Systemic factors and mortality in elderly patients with pressure ulcers" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "E. Jaul" 1 => "R. Calderon-Margalit" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/iwj.12086" "Revista" => array:6 [ "tituloSerie" => "Int Wound J" "fecha" => "2015" "volumen" => "12" "paginaInicial" => "254" "paginaFinal" => "259" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23692122" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0200" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effects of a minimal reminder intervention to reduce the length of urinary catheterization and intravenous fluids therapy for internal medicine inpatients: a parallel controlled clinical trial" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "J. Díez-Manglano" 1 => "C. Palazón-Fraile" 2 => "M. Sevil-Puras" 3 => "M.J. Arnal-Longares" 4 => "S. Terrén-Portolés" 5 => "S. Alcubierre-Iriarte" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Nurs Educ Pract" "fecha" => "2016" "volumen" => "6" "paginaInicial" => "74" "paginaFinal" => "80" ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0205" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Factors associated with onset of delirium among Internal Medicine inpatients in Spain" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. Díez-Manglano" 1 => "C. Palazón-Fraile" 2 => "F. Diez-Massó" 3 => "R. Martínez-Álvarez" 4 => "E. del Corral-Beamonte" 5 => "P. Carreño-Borrego" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/NNR.0000000000000004" "Revista" => array:6 [ "tituloSerie" => "Nurs Res" "fecha" => "2013" "volumen" => "62" "paginaInicial" => "445" "paginaFinal" => "449" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24165221" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0210" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Functional evaluation: the Barthel index" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "F.I. Mahoney" 1 => "D.W. Barthel" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Md State Med J" "fecha" => "1965" "volumen" => "14" "paginaInicial" => "61" "paginaFinal" => "65" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/5832033" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0215" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "An investigation of geriatric problems in hospital" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "D. Norton" 1 => "R. McLaren" 2 => "A.N. Exton-Smith" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:4 [ "edicion" => "3rd ed." "fecha" => "1979" "editorial" => "Churchill-Livingstone" "editorialLocalizacion" => "London" ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0220" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "EPUAP classification system for pressure ulcers: European reliability study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D. Beeckman" 1 => "L. Schoonhoven" 2 => "J. Fletcher" 3 => "K. Furtado" 4 => "L. Gunningberg" 5 => "H. Heyman" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1365-2648.2007.04474.x" "Revista" => array:6 [ "tituloSerie" => "J Adv Nurs" "fecha" => "2007" "volumen" => "60" "paginaInicial" => "682" "paginaFinal" => "691" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18039255" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0225" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalencia de úlceras por presión en la Comunidad Autónoma de las Islas Baleares" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "por el Grupo de trabajo" "etal" => false "autores" => array:5 [ 0 => "A.M. Tomás-Vidal" 1 => "M.S. Hernández-Yeste" 2 => "M.D. García-Raya" 3 => "R. Marín-Fernández" 4 => "J. Cardona-Roselló" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.enfcli.2011.03.005" "Revista" => array:6 [ "tituloSerie" => "Enferm Clin" "fecha" => "2011" "volumen" => "21" "paginaInicial" => "202" "paginaFinal" => "209" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21763170" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0230" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "La validez de un registro clínico de úlceras por presión" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "T. Sebastián-Viana" 1 => "J.M. González-Ruiz" 2 => "F. Núñez-Crespo" 3 => "I. Lema-Lorenzo" 4 => "G. Gadea-Romero" 5 => "M.E. Losa-Iglesias" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "An Sist Sanit Navar" "fecha" => "2014" "volumen" => "37" "paginaInicial" => "17" "paginaFinal" => "24" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24871107" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0235" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Predictive capacity of risk assessment scales and clinical judgment for pressure ulcers. A metanalysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "F.P. García-Fernández" 1 => "P.L. Pancorbo-Hidalgo" 2 => "J.J. Soldevilla-Agreda" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/01.WON.0000438014.90734.a2" "Revista" => array:6 [ "tituloSerie" => "J Wound Ostomy Continence Nurs" "fecha" => "2014" "volumen" => "41" "paginaInicial" => "24" "paginaFinal" => "34" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24280770" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0240" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Generalitat Valenciana, Consellería de Sanitat. Guía de práctica clínica para el cuidado de personas con úlceras por presión o riesgo de padecerlas. Valencia, 2012. Available at: <a id="intr0010" class="elsevierStyleInterRef" href="http://www.guiasalud.es/GPC/GPC_520_Ulceras_por_presion_compl.pdf">http://www.guiasalud.es/GPC/GPC_520_Ulceras_por_presion_compl.pdf</a> [accessed 07.06.16]." ] ] ] 21 => array:3 [ "identificador" => "bib0245" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "Available at: <a class="elsevierStyleInterRef" id="intr0015" href="http://www.npuap.org/wp-content/uploads/2014/08/Quick-Reference-Guide-DIGITAL-NPUAP-EPUAP-PPPIA-Jan2016.pdf">http://www.npuap.org/wp-content/uploads/2014/08/Quick-Reference-Guide-DIGITAL-NPUAP-EPUAP-PPPIA-Jan2016.pdf</a> [accessed 07.06.16]" "contribucion" => array:1 [ 0 => array:1 [ "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel and Pan Pacific Pressure Injury Alliance" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:2 [ "titulo" => "Prevention and treatment of pressure ulcers: quick reference guide" "serieFecha" => "2014" ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0250" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hospital-acquired pressure ulcers. Risk factors and use of preventive devices" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "T.V. Perneger" 1 => "C. Héliot" 2 => "A.C. Raë" 3 => "F. Borst" 4 => "J.M. Gaspoz" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arch Intern Med" "fecha" => "1998" "volumen" => "158" "paginaInicial" => "1940" "paginaFinal" => "1945" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9759692" "web" => "Medline" ] ] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0255" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The burden of pressure ulcers in Spain" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.J. Soldevilla Agreda" 1 => "I. Torra" 2 => "J.E. Bou" 3 => "J. Posnett" 4 => "J. Verdu Soriano" 5 => "L. San Miguel" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Wounds" "fecha" => "2007" "volumen" => "19" "paginaInicial" => "201" "paginaFinal" => "206" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26110336" "web" => "Medline" ] ] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0260" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Ministerio de Sanidad, Servicios Sociales e Igualdad. Norma estatal. Resultados según la versión 27 de los AP-GRD. Available at: <a id="intr0020" class="elsevierStyleInterRef" href="http://www.msssi.gob.es/estadEstudios/estadisticas/cmbd.htm">http://www.msssi.gob.es/estadEstudios/estadisticas/cmbd.htm</a> [accessed 07.06.16]." ] ] ] 25 => array:3 [ "identificador" => "bib0265" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Determinants of mortality among older adult with pressure ulcers" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "H.M. Khor" 1 => "J. Tan" 2 => "N.I. Saedon" 3 => "S.B. Kamaruzzaman" 4 => "A.V. Chin" 5 => "P.J.H. Poi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.archger.2014.07.011" "Revista" => array:6 [ "tituloSerie" => "Arch Gerontol Geriatr" "fecha" => "2014" "volumen" => "59" "paginaInicial" => "536" "paginaFinal" => "541" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25091603" "web" => "Medline" ] ] ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0270" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Development of a six-month prognostic index in patients with advanced chronic medical conditions: the PALIAR score" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "on behalf of the PALIAR Researchers" "etal" => true "autores" => array:6 [ 0 => "M. Bernabeu-Wittel" 1 => "J. Murcia-Zaragoza" 2 => "C. Hernández-Quiles" 3 => "B. Escolano-Fernández" 4 => "Guadalupe Jarava-Rol" 5 => "M. Oliver" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jpainsymman.2013.04.011" "Revista" => array:6 [ "tituloSerie" => "J Pain Symptom Manage" "fecha" => "2014" "volumen" => "47" "paginaInicial" => "551" "paginaFinal" => "565" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23998780" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/22548874/0000021600000009/v1_201611291252/S2254887416300613/v1_201611291252/en/main.assets" "Apartado" => array:4 [ "identificador" => "1901" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original Articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/22548874/0000021600000009/v1_201611291252/S2254887416300613/v1_201611291252/en/main.pdf?idApp=WRCEE&text.app=https://revclinesp.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887416300613?idApp=WRCEE" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2023 March | 12 | 7 | 19 |
| 2018 July | 1 | 0 | 1 |
| 2016 December | 0 | 1 | 1 |
| 2016 November | 0 | 1 | 1 |
| 2016 October | 0 | 2 | 2 |
