Original article
Ophthalmological emergencies. An epidemiological study: Are resources been used properly?
Oftalmología de urgencias. Un estudio epidemiológico: ¿se utilizan correctamente los recursos?
F.B. Domínguez-Serranoa, P. Molina-Solanaa,
, M. Infante-Cossíoa,b, J. Sala-Turrensc, N. Seva-Silvad, E. Rodríguez-de-la-Rúa-Francha,b
Corresponding author
a UGC Oftalmología, Hospital Universitario Virgen Macarena, Sevilla, Spain
b Departamento de Cirugía, Universidad de Sevilla, Sevilla, Spain
c Departamento de Documentación Clínica, Hospital Universitario Virgen Macarena, Sevilla, Spain
d UGC Oftalmología, Hospital Universitario Virgen del Rocío, Sevilla, Spain
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"tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "211" "paginaFinal" => "217" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "F.B. Domínguez-Serrano, P. Molina-Solana, M. Infante-Cossío, J. Sala-Turrens, N. Seva-Silva, E. Rodríguez-de-la-Rúa-Franch" "autores" => array:6 [ 0 => array:3 [ "nombre" => "F.B." "apellidos" => "Domínguez-Serrano" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:4 [ "nombre" => "P." "apellidos" => "Molina-Solana" "email" => array:1 [ 0 => "pedroms912@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 2 => array:3 [ "nombre" => "M." 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"apellidos" => "Rodríguez-de-la-Rúa-Franch" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "UGC Oftalmología, Hospital Universitario Virgen Macarena, Sevilla, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Departamento de Cirugía, Universidad de Sevilla, Sevilla, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Departamento de Documentación Clínica, Hospital Universitario Virgen Macarena, Sevilla, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "UGC Oftalmología, Hospital Universitario Virgen del Rocío, Sevilla, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Oftalmología de urgencias. Un estudio epidemiológico: ¿se utilizan correctamente los recursos?" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0025" "etiqueta" => "Fig. 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr5.jpeg" "Alto" => 1333 "Ancho" => 2473 "Tamanyo" => 166178 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Evolution of emergencies in the course of the day. Vertical axis refers to the number of consultations.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">In 2014 and 2015, the University hospitals included in the present study were inter-center clinic management and care units, providing coverage 24<span class="elsevierStyleHsp" style=""></span>h a day and 7 days a week to a population of over 2 million people.<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">1,2</span></a> Hospital emergencies constitute a significant part of the clinic care provided by said hospitals. Despite the large number of ophthalmological patients who were cared for in the emergency departments, which has increased in recent years,<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">3</span></a> very few studies have been published on the epidemiology of the visits to said departments, both in Spain and abroad.<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">4–6</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Accordingly, the authors considered that a descriptive study on visits to ophthalmological emergency departments was necessary to determine the epidemiological characteristics of patients. The aim of this information is to detect behavior patterns and the promotion of changes in order to improve the efficiency of resource management as well as to increase the quality of the care provided to patients.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material and methods</span><p id="par0015" class="elsevierStylePara elsevierViewall">A descriptive study of the visits to ophthalmological emergencies that included all patients who consecutively visited all the hospitals included in the study from January 2014 up to December 31, 2015 and registered in the database of the Clinic Documentation Department of both hospitals. Study variables comprised sex, age (grouped in ≤14<span class="elsevierStyleHsp" style=""></span>years, 15–41<span class="elsevierStyleHsp" style=""></span>years, 42–64<span class="elsevierStyleHsp" style=""></span>years and ≥65<span class="elsevierStyleHsp" style=""></span>years), time, date, month and year of the visit, level of priority (determined by nursing staff prior to the consultation by means of the Manchester triage system, creating 2 groups according to priority: urgent for levels 1, 2 and 3 and non-urgent for levels 4 and 5), diagnostic (including traumatic or nontraumatic pathology), destination upon release (patients’ home, admission to hospital, transfer to other departments or hospitals, voluntary discharge, leavers and patients who did not respond to calls), geographic area of origin (capital city, same or other provinces), patient visits due to referral by primary care physician or personal initiative, as well as overall attention time from entering the hospital to ophthalmological discharge.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Upon admission, pathologies were coded according to the International Disease Classification, revision 9, clinic modification (CIE-9, MC) dated in January 2014. This task was performed by the emergency ophthalmologist when filling in the admission report. Ocular pathologies were categorized according to CIE-9 MC as non-traumatic or traumatic. The codes used for nontraumatic ocular and adnexal pathology were from 360.0 to 379.99, and those used for traumatic pathology were from 802.6 to 802.7 (orbital fractures), from 870.0 to 871.9 (open wounds), from 918.0 to 918.9 (superficial eye and adnexa injuries), from 921.0 to 921.9 (ocular and adnexa injuries), from 930.0 to 930.9 (foreign bodies in ocular surface), from 940.0 to 940.9 (Burns in eyes and adnexa) and from 950.0 to 951.3 (lesions from optic nerve and nerve pathways from the eye and lesions of other cranial nerves).</p><p id="par0025" class="elsevierStylePara elsevierViewall">Obtained data were collected in an Excel database (Microsoft Office for Windows) and analyzed with the SPSS application version 22 (SPSS Inc, Chicago, IL, USA), performing an exploratory data analysis to identify atypical values in the overall sample of the study and in the subgroups.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Frequency distribution tables were utilized for descriptive analysis in the case of qualitative variables, and centralization and dispersion measurements for quantitative variables (mean and typical deviation for variables with symmetric distribution).</p><p id="par0035" class="elsevierStylePara elsevierViewall">Contingency tables were drawn up to assess qualitative variables, applying Pearson Chi square test, Chi square with continuity correction or Fishers exact probability (sparsely populated Tables 2<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>2) according to application criteria. A significance level of 0.05 was considered for the comparison of all hypotheses.</p><p id="par0040" class="elsevierStylePara elsevierViewall">At all times, patient autonomy and confidentiality was preserved by the study. It was not necessary to obtain individual consents of patients due to the fact that the database did not include personal identifiers.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0045" class="elsevierStylePara elsevierViewall">In the course of 2014 and 2015, a total of 32,679 visits were made to the emergency departments of both hospitals (4% of all emergencies), a mean of 27.3<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>9.98 visits per day and an estimated incidence of 19.2 visits for every 1000 individuals in said period.</p><p id="par0050" class="elsevierStylePara elsevierViewall">The mean age of patients was 46.24<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>23.2<span class="elsevierStyleHsp" style=""></span>years. Overall, females were the most frequent (53%) excepting the under-44 group with a majority of male patients. Consultations took place more frequently between April and June, on Monday mornings, i.e., from 8:00 up to 15:00 (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.01) (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">Overall, 73.42% of visits were classified upon arrival at the emergency departments as non-urgent against 26.58% defined as urgent (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.01). The latter type was more frequent among females in the 45–60 age group, from Monday to Friday in the morning.</p><p id="par0060" class="elsevierStylePara elsevierViewall">In the 2 years of the study, 64.38% of all visits were comprised within the 10 most frequent codes (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). In contrast, severe pathologies such as retina detachment, orbital cellulite or retinal vascular pathologies did not reach 2% of all ophthalmological emergencies.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">94.85% of all attended patients were released at the end of the consultation, with under 1% requiring admittance to the hospital. Admittance was more frequent among women and patients over 65 years of age (20% of all admittances). Of these, orbital cellulite accounted for 22.89% followed by traumatic ocular perforation and optic nerve pathologies (mainly papiledema and acute retrobulbar optic neuritis) with 13% each.</p><p id="par0070" class="elsevierStylePara elsevierViewall">On the basis of the classification of pathologies as traumatic and nontraumatic as per the CIE-9, MC system, differences were observed in the pattern of visits to emergency departments. Accordingly, nontraumatic pathologies accounted for 81.96% of visits against 18.04% of traumatic pathologies. The latter were more frequent in males (53.35%) and in younger patients (predominantly in the 15–49 age group) accounting for 46.19% of consultations. Traumatic pathology consultations increased during the weekends and exhibited a higher percentage of urgent consultations (35.21% against 24.68%) and hospital admittances (1% against 0.008%). In addition, traumatic pathologies exhibited a more homogeneous distribution of consultations throughout the day, whereas nontraumatic pathologies were more predominant in the morning shift.</p><p id="par0075" class="elsevierStylePara elsevierViewall">In what concerns the origin of patients, 61.05% came from the same capital city of the hospital, 37.25% from towns of the same province and 1.7% from other provinces of the Autonomous Community. The mean distance traveled by each patient to reach the emergencies Dept. was 8.49<span class="elsevierStyleHsp" style=""></span>km. A linear relationship was obtained between the distance to the hospitals and the number of visits (<span class="elsevierStyleItalic">R</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.01). On the other hand, 5.24% of patients visited the emergency departments by referral from primary care, with the remainder (94.76%) visiting independently, without previous consultation with the primary care physician. The mean time spent at the emergency departments during the consultation was 94<span class="elsevierStyleHsp" style=""></span>min.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0080" class="elsevierStylePara elsevierViewall">The decision to attend an Emergency Dept. is complex and involves a large amount of patient-related variables such as sociocultural environment and social customs such as working time, daily life activities and holiday periods.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">7</span></a> On the basis of collected data, the present study was able to relate the way in which said factors play a significant role in the number of patients and epidemiological characteristics of visits to ophthalmological emergency services.</p><p id="par0085" class="elsevierStylePara elsevierViewall">Firstly, in what concerns the time of consultation, 2 different patterns of distribution were established on the basis of the month of the year. During the autumn and winter season an M-pattern was observed with 2 peak periods, the first between 12:00 and 14:00<span class="elsevierStyleHsp" style=""></span>h, and the second between 17:00 and 19:00<span class="elsevierStyleHsp" style=""></span>h, both separated by a minimum number of visits at 16:00<span class="elsevierStyleHsp" style=""></span>h. As of 20:00<span class="elsevierStyleHsp" style=""></span>h the number of consultations drops sharply to reach a minimum at midnight. On the other hand, during the warm spring and summer months a plateau pattern was observed, characterized by maximum peaks slightly later than in the cold season, separated by a less sharp fall of consultations. The drop in the number of consultations as of 20:00<span class="elsevierStyleHsp" style=""></span>h is less evident and the minimum is reached 1<span class="elsevierStyleHsp" style=""></span>h later than in autumn and winter (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">On the other hand, a further 2 timetable patterns were observed for weekdays and weekends. From Monday to Friday, the M-pattern is again observed, peaking at midday and midafternoon with sharp drop of consultations after 20:00<span class="elsevierStyleHsp" style=""></span>h with the exception of Friday afternoon, which could be regarded as part of the weekend. During Saturdays and Sundays, a complex QRS pattern was observed characterized by a peak of consultations at midday, a sustained number of visits in the course of the afternoon, while the drop after 20:00<span class="elsevierStyleHsp" style=""></span>h is considerably less sharp than on Monday to Thursday (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">In addition, said patterns also show the influence of various economic, social and labor factors that influence visits to emergency departments. Accordingly, in the age range of the active working population (18–65<span class="elsevierStyleHsp" style=""></span>years), the distribution of visits matches that of working hours, which influences the M-pattern (with peaks at 13:00 and 18:00<span class="elsevierStyleHsp" style=""></span>h) observed from Monday to Friday and in autumn and winter, typically not holiday periods. On the other hand, in the age group over 65 the number of visits peaks around midday (11:00–12:00<span class="elsevierStyleHsp" style=""></span>h) without a marked peak during the afternoon. Therefore, and on the basis of obtained data, a relationship between working hours and the time of visiting emergency departments could be suggested (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>). In addition, sporting and leisure activities that are usually carried out over the weekend and during months with more sunlight play a significant role on traumatic pathologies seen at the emergency departments, and significantly determines the amount of consultations during weekends and in the late hours of the day, therefore being more significant in the warmer and holiday months.</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">The most frequently observed pathologies match the reports in previous national<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">4</span></a> and international<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">5,6</span></a> studies, including a large amount of pathologies classified as non-urgent. This classification depended on the Manchester triage system utilized in the authors’ region and in other emergency Depts. of Spain.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">8</span></a> Said triage system is based on the selection of one out of 52 reasons for a consultation and utilizes Yes/No questions to enable a fast classification of patients in one of the previously described 5 levels.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">9</span></a> The literature comprises studies on the prejudice involved in non-urgent pathologies in hospitals, both at the economic level and in the excessive use of diagnostic tests, including overtreatment, increased waiting times for receiving care and the weakening of the relationship between patients and their primary care physician.<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">10–13</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">Over half of nontraumatic pathologies, which comprise the majority of chronic and non-urgent conditions, visited emergency departments between 8:00 and 15:00<span class="elsevierStyleHsp" style=""></span>h while traumatic pathologies, which have a higher incidence in urgent pathologies, appeared indistinctly in all shifts. This suggests that patients with non-urgent pathologies, who are predominantly in the ≥65<span class="elsevierStyleHsp" style=""></span>years age group, exhibit a preference to visit emergency departments during the morning. This correlates to the hourly distribution of priority levels of emergencies, according to which from 08:00 to 20:00<span class="elsevierStyleHsp" style=""></span>h predominantly level 5 pathologies are consulted, whereas after 20:00<span class="elsevierStyleHsp" style=""></span>h and until 08:00<span class="elsevierStyleHsp" style=""></span>h the following morning, the predominant type of pathologies are those classified as level 3 (<a class="elsevierStyleCrossRef" href="#fig0025">Fig. 5</a>).</p><elsevierMultimedia ident="fig0025"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall">An additional noteworthy finding is the high percentage of patients who visit the Ophthalmology Emergencies Dept. of their own accord, without previously consulting their primary care physician. This could be due to the belief that they will receive better care in a hospital in the hands of an ophthalmologist. The present study also found an inverse relationship between the distance from the place of origin of patients with the visits to the emergencies Dept. which could indicate that patients who live further away from the hospital preferred to consult initially at their primary health care center instead of going to the hospital.</p><p id="par0115" class="elsevierStylePara elsevierViewall">The weak points of the present study include the inability of relating visits to emergency departments with patient income, which was the object of past studies<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">14,15</span></a> that found a relationship between high middle income levels and increased use of health services, either due to increased availability of private hospitals, safer jobs or better health prospects. In the present case, as the study was carried out in public hospitals that are not associated to any type of health insurance, it was not possible to determine the income level of patients.</p><p id="par0120" class="elsevierStylePara elsevierViewall">In order to obtain a broader viewpoint it would be convenient to carry out more epidemiological studies encompassing not only ophthalmological hospital emergencies. This would enable a comparison between patterns and a more precise definition of possible actions to improve healthcare and optimize available resources.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conclusions</span><p id="par0125" class="elsevierStylePara elsevierViewall">According to the results of the study, it can be suggested that ophthalmological emergency consultation in the authors’ country exhibit a higher percentage of primary care ophthalmology in comparison to clearly urgent pathologies, involving higher care and financial burdens for said departments. Accordingly, increased use of primary care practices which could resolve the majority of ophthalmological care requirements (adequately provided with sufficient resources) could improve the efficiency of emergency ophthalmological care through shorter waiting times and enable greater focus on emergency pathologies that inevitably require hospital care.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Funding</span><p id="par0130" class="elsevierStylePara elsevierViewall">The authors are members of OFTARED “RD16/0008/0010”, Instituto de Salud Carlos III, part of the national R+D+i and co-funded by the European Union (“Investing in Our Future”).</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conflict of interests</span><p id="par0135" class="elsevierStylePara elsevierViewall">No conflict of interests was declared by the authors.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:3 [ "identificador" => "xres1184801" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objectives" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1104910" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1184800" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1104911" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Material and methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conclusions" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Funding" ] 10 => array:2 [ "identificador" => "sec0035" "titulo" => "Conflict of interests" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2018-10-29" "fechaAceptado" => "2019-01-30" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1104910" "palabras" => array:5 [ 0 => "Emergency" 1 => "Ophthalmology" 2 => "Epidemiology" 3 => "Resources" 4 => "Efficiency" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1104911" "palabras" => array:5 [ 0 => "Urgencias" 1 => "Oftalmología" 2 => "Epidemiología" 3 => "Recursos" 4 => "Eficiencia" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objectives</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To determine the prevalence of ophthalmological emergency visits to two tertiary hospital in all age groups during years 2014 and 2015.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">All patients who attended Ophthalmological Emergency Department from 1 January 2014 to 31 December 2015 were included in the study. The demographic variables studied were gender, age, place of origin, time of arrival, day of the week, month and year of the visit, the diagnosis, destination on discharge, total time of the visit and priority. Pathologies were categorized using codes from ICD-9, CM.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A total of 39,869 visits were made between 2014 and 2015. Emergency consultations were more frequent among women, on Mondays, and from April to June. The mean age of the patients was 46.24<span class="elsevierStyleHsp" style=""></span>years old, and 73.42% of visits were classified as non-emergencies. The most frequent pathology was conjunctivitis (17.28%), followed by keratitis (15.31%), and vitreous detachment (5.37%). The pathology that led to more hospital admissions was orbital cellulitis (23%). The majority of patients (94.85%) were sent to their place of residence after the visit.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Given that the great majority of Ophthalmological Emergency visits are categorized as non-emergencies, measures need to be set up in order achieve a more effective care focused on emergency pathology without using unnecessary resources.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objectives" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "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 epidemiología de todas las visitas a urgencias oftalmológicas incluyendo todos los grupos de edad durante los años 2014 y 2015 en dos hospitales de tercer nivel.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Métodos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Fueron incluidos todos los pacientes que acudieron a urgencias oftalmológicas desde el 1 de enero de 2014 al 31 de diciembre de 2015. Las variables estudiadas fueron el sexo, la edad, el lugar de procedencia, la hora de llegada, el día de la semana, el mes y el año de la visita, el diagnóstico, el lugar de derivación al alta, el nivel de prioridad y el tiempo total de asistencia. Las patologías fueron clasificadas según los códigos CIE-9, MC.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se produjeron un total de 39.869 visitas a urgencias entre los años 2014 y 2015. Estas fueron más frecuentes en el sexo femenino, los lunes y en los meses de abril, mayo y junio. La edad media fue de 46,24<span class="elsevierStyleHsp" style=""></span>años. El 73,42% de las visitas se clasificaron como no urgentes. La patología más frecuente atendida fue la conjuntivitis (17,28%), seguida de queratitis (15,31%) y desprendimiento de vítreo posterior (5,37%). La celulitis orbitaria fue la patología que cursó con un mayor porcentaje de ingresos (23%). La mayoría de los pacientes fueron derivados al alta a su domicilio (94,85%).</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Dado que la gran mayoría de patologías atendidas en urgencias son no urgentes, es conveniente el establecimiento de medidas para conseguir una asistencia más eficiente, orientada a la patología urgente y que no consuma recursos innecesarios.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Domínguez-Serrano FB, Molina-Solana P, Infante-Cossío M, Sala-Turrens J, Seva-Silva N, Rodríguez-de-la-Rúa-Franch E. Oftalmología de urgencias. Un estudio epidemiológico: ¿se utilizan correctamente los recursos? Arch Soc Esp Oftalmol. 2019;94:211–217.</p>" ] ] "multimedia" => array:6 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1328 "Ancho" => 2347 "Tamanyo" => 91774 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Most frequent pathologies in ophthalmological emergencies. Vertical axis refers to the number of consultations.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1400 "Ancho" => 2531 "Tamanyo" => 153665 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">M and plateau patterns according to month of year. Vertical axis refers to the number of consultations.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1366 "Ancho" => 2528 "Tamanyo" => 254528 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">M-pattern and complex QRS based on day of week. Vertical axis refers to the number of consultations.</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Fig. 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1450 "Ancho" => 2522 "Tamanyo" => 196582 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Consultations per hour and age range. Vertical axis refers to the number of consultations.</p>" ] ] 4 => array:7 [ "identificador" => "fig0025" "etiqueta" => "Fig. 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr5.jpeg" "Alto" => 1333 "Ancho" => 2473 "Tamanyo" => 166178 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Evolution of emergencies in the course of the day. Vertical axis refers to the number of consultations.</p>" ] ] 5 => 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:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variable \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">2014 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">2015 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Total (<span class="elsevierStyleItalic">n</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" title="table-entry " colspan="4" 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">6844 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7069 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13,913 \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">9282 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9484 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18,766 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" 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="4" align="left" valign="top"><span class="elsevierStyleItalic">Months of year</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>January–March \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3924 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4042 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7966 \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>April–June \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4114 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4412 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8526 \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>July–September \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3912 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4194 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8106 \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>October–December \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4176 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3905 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8081 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" 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="4" align="left" valign="top"><span class="elsevierStyleItalic">Day of week</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>Monday \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2780 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2765 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5545 \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>Tuesday \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2439 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2473 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4912 \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>Wednesday \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2414 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2411 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4825 \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>Thursday \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2246 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2379 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4625 \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>Friday \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2477 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2565 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5042 \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>Saturday \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1944 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2031 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3975 \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>Sunday \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1826 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1929 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3755 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" 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="4" align="left" valign="top"><span class="elsevierStyleItalic">Level of emergency</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>1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">23 \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>2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">520 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">365 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">885 \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>3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3972 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3186 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7158 \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>4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4053 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5961 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10,014 \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>5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7571 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7028 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14,599 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" 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="4" align="left" valign="top"><span class="elsevierStyleItalic">Origin</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>Capital \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9742 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10,005 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19,747 \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>Province \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6218 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6382 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12,600 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" 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="4" align="left" valign="top"><span class="elsevierStyleItalic">Discharged to</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>Home \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15,376 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15,715 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">31,091 \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>Hospital admittance \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">139 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">150 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">289 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" 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="4" align="left" valign="top"><span class="elsevierStyleItalic">Shift</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>Morning (08.00–15.00<span class="elsevierStyleHsp" style=""></span>h) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8540 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8091 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16,631 \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>Afternoon (15.00–20.00<span class="elsevierStyleHsp" style=""></span>h) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4914 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5051 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9965 \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>Night (20.00–08.00<span class="elsevierStyleHsp" style=""></span>h) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2672 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3411 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6083 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2019727.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Total number of visits seen in Emergencies per year based on sex, month, day, level of emergency, origin, destination upon release and shift.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:15 [ 0 => array:3 [ "identificador" => "bib0080" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Junta de Andalucía. 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