Validation of a Rapid Antigen Test in the Diagnosis of Pharyngitis Caused by Group A Beta-Haemolytic Streptococcus
Validación de una técnica antigénica rápida en el diagnóstico de la faringitis por estreptococo betahemolítico del grupo A
Carles Llora, Silvia Hernández Anadóna, Frederic Frances Gómez Bertomeub, Josep Maria Santamaria Puigb, Olga Calviño Domínguezaa, Yvonne Fernández Pagésa
a Family Medicine, Jaume I Health Centre, Tarragona, Spain.
b Microbiology Department, Joan XXIII Hospital, Tarragona, Spain. Funding: The Genzyme OSOM StrepA strips were free of charge and provided Laboratorio Leti. We have not received any direct or indirect funding from this Laboratory for carrying out this study.
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"etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] 1 => array:3 [ "entidad" => "Microbiology Department, Joan XXIII Hospital, Tarragona, Spain. Funding: The Genzyme OSOM StrepA strips were free of charge and provided Laboratorio Leti. We have not received any direct or indirect funding from this Laboratory for carrying out this study." "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "affb" ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Validación de una técnica antigénica rápida en el diagnóstico de la faringitis por estreptococo betahemolítico del grupo A" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "27v40n10-13127243fig01.jpg" "Alto" => 1583 "Ancho" => 995 "Tamanyo" => 221651 ] ] "descripcion" => array:1 [ "en" => "General Scheme of the Study. Prospective, observational study, carried out between January 2007 and March 2008. *One patient had nausea during the procedure, although the 2 swabs could be collected.GABHS indicates group A beta-haemolytic Streptococcus." ] ] ] "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold"> Introduction</span></p><p class="elsevierStylePara">Pharyngitis, along with rhinitis, is the most common reason for being seen by a primary care doctor in</p><p class="elsevierStylePara"> Spain.<span class="elsevierStyleSup">1</span> It is also one of the most common reasons for prescribing antibiotics in our country, with an estimated prescription rate of 80%<span class="elsevierStyleSup">1-3</span>; despite this, only 50% of pharyngitis in children and 15%-25% of adults is of bacterial origin.<span class="elsevierStyleSup">2-4</span> It should be systematically treated with antibiotics as, according to meta-analyses carried out, most pharyngitis is cured without antibiotics being given.<span class="elsevierStyleSup">5</span> Only infections caused by <span class="elsevierStyleItalic"><span class="elsevierStyleItalic">Streptococcus pyogenes</span></span> or group A beta-haemolytic <span class="elsevierStyleItalic"><span class="elsevierStyleItalic">Streptococcus</span></span> (GABHS) require the use of an antibiotic, as it stops the transmission and spreading of <span class="elsevierStyleItalic"><span class="elsevierStyleItalic">S pyogenes</span></span> in the community, reduces the symptomatology compared to the non-treated group in a mean of 16 hours, and because it prevents suppurative complications. According to the Cochrane review, for every 100 patients treated with antibiotics compared to the group assigned to the placebo it produces 1 case less of rheumatic fever, 2 cases less of acute otitis media, and 3 cases less of peritonsillar abscess.<span class="elsevierStyleSup">5,6</span> However, the majority of studies included in this review were carried out in the 1950's and 60's, and the incidence of complications is much less in the last 20 years or so than in the period when these clinical studies were performed.<span class="elsevierStyleSup">7</span> A paper was recently published in the United Kingdom confirmed that the decrease in prescribing antibiotics for the treatment of pharyngitis in the last few years is not accompanied by a greater number of cases of rheumatic fever or peritonsillar abscesses.<span class="elsevierStyleSup">8</span> Acute pharyngitis creates problems for the primary care doctor, since it is difficult to clinically differentiate the aetiology due to GABHS from that of nonstreptococcal origin. Its diagnostic standard is still the pharyngeal culture, but this has significant limitations, such as the delay in obtaining the results and, also, it does not help in distinguishing between acute infection and a carrier state.</p><p class="elsevierStylePara">Clinical criteria are normaly used in practice to identify patients who need to be treated with antibiotics. In this case, the most well-known are the 4 criteria proposed by Centor<span class="elsevierStyleSup">9</span>: presence or history of fever, tonsillar exudate, painful lateral cervical lymph nodes, and absence of cough. Later, McIsaac also included age, with an age less than 15 years being considered as another criterion.<span class="elsevierStyleSup">10</span> In the last few years, new rapid antigen techniques (RAT) have been developed for the diagnosis of acute pharyngeal tonsillitis caused by GABHS, with improved sensitivity and specificity than those of the 1990's. In this study we aim to assess the validity of the Genzyme OSOM StrepA in patients with 2 or more Centor criteria.</p><p class="elsevierStylePara"><img src="27v40n10-13127243fig01.jpg"></img></p><p class="elsevierStylePara"><span class="elsevierStyleBold"> Methods</span></p><p class="elsevierStylePara">This was a prospective observational study carried out between January 2007 and March 2008. Patients over 14 years old seen in 6 clinics in our health centre were consecutively include if they had clinical symptoms of odynophagia and 2 or more of Centor criteria: tonsillopharyngeal exudate, painful lateral cervical lymph nodes, absence of cough, and/or presence or history of fever (>38<span class="elsevierStyleSup">o</span>C). Patients were excluded if they had received antibiotic treatment in the previous 2 weeks and if a swab could not be collected. The sample size was calculated to be 170 subjects for a precision of 6% and expected proportion of 20%, with a 95% confidence interval (95% CI). A data report form was prepared which contained, age, sex, presence of these 4 criteria and whether the infection was recurrent (less than 2 months since the last episode) or non-recurrent.Two samples were taken for the culture from each patient for this study, by swabbing the tonsils and/or posterior wall of the pharynx with a swab, without touching the tongue, teeth or gums. The samples were taken by the 6 family doctors who had been previously trained to carry out the correct technique. OSOM StrepA (Laboratorio Genzyme) following the manufacturers instructions, was performed on one of the samples. The other swab, using an AMIES type transport medium (Copan Innovation Italy), was sent to the Microbiology Department of the Joan XXIII Hospital, Tarragona, Spain. It was cultivated on a blood agar plate and incubated at a temperature of 37<span class="elsevierStyleSup">o</span>C in a 5% CO<span class="elsevierStyleInf">2</span> atmosphere for 48 hours. The culture was considered positive for <span class="elsevierStyleItalic"><span class="elsevierStyleItalic">S pyogenes</span></span> if there was, growth of any number beta-haemolytic colonies, a positive Gram stain with streptococcal morphology, and a negative catalase test, with subsequent identification using a WIDER automated screen (Francisco Soria Melguizo) for Gram positive cocci. The results were then confirmed by serotyping using the Streptococcal Grouping Kit (Oxford, United Kingdom). The culture was considered negative if there were no beta-haemolytic colonies seen after 48 hours incubation.</p><p class="elsevierStylePara">For the statistical analysis, the c<span class="elsevierStyleSup">2</span> test was used for the analysis of the qualitative variables and the Student-Fisher <span class="elsevierStyleItalic"><span class="elsevierStyleItalic">t</span></span> test was used for comparing the means. The sensitivity, specificity, the positive predictive value, and the negative predictive value were calculated for the different Centor criteria and for the RAT. Values of <span class="elsevierStyleItalic"><span class="elsevierStyleItalic">P</span></span><.05 were considered to be statistically significant differences.</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Results Results</span></p><p class="elsevierStylePara">The study included 184 consecutive patients with pharyngitis symptoms and at least 2 Centor criteria, and as 2 swabs were lost in transport to the Microbiology Department, there were 182 evaluable cases (see the General Scheme of the Study). The mean age was 30.6±12.1 years, with 116 females (63.7%). A total of 63 patients had 2 Centor criteria, 83 had 3 criteria, and 36 patients with 4 criteria. The Centor criteria most often seen in the patients was, tonsillopharyngeal exudate (158 cases; 86.8%), followed by a history of fever (140 cases; 76.9%); while the least frequent was the presence of painful lateral cervical lymph nodes (89 cases; 48.9%). The culture was positive for any microorganism in 102 cases (56%), and was more common among those who had 4 criteria (25 cases; 69.4%), with no statistically significant differences seen with the other patient groups. Table 1 shows the aetiology according to the number of Centor criteria, and the different aetiological agents isolated in the cultures are shown in Figure 1.</p><p class="elsevierStylePara"><img src="27v40n10-13127243fig02.jpg"></img></p><p class="elsevierStylePara"><img src="27v40n10-13127243fig03.jpg"></img></p><p class="elsevierStylePara"><span class="elsevierStyleBold">FIGURE 1</span> Aetiology observed in the pharyngeal cultures.</p><p class="elsevierStylePara">No statistically significant differences were observed between sex and the incidence of streptococcal tonsillopharyngitis. The mean age of those with positive GABHS was slightly lower than those who had negative cultures, although no statistically significant differences were seen (29.7±11 compared to 30.9±12.3 years). The incidence of GABHS infection was significantly higher among those with 4 Centor criteria, followed by the patients with 3 criteria and then those who had only 2 criteria (<span class="elsevierStyleItalic"><span class="elsevierStyleItalic">P</span></span>>.001).</p><p class="elsevierStylePara">The Centor criteria associated with a higher frequency of infection due to GABHS was the absence of cough and the presence of painful lateral-cervical lymph nodes. Thus, GABHS was isolated in 27.6% of patients who did not have a cough, a significantly higher percentage than that observed among subjects who did have a cough (9.1%; <span class="elsevierStyleItalic"><span class="elsevierStyleItalic">P</span></span><.01). GABHS infection is seen more often among patients who have painful lateral-cervical lymph nodes (29.2% compared to 15.1% in those who do not; <span class="elsevierStyleItalic"><span class="elsevierStyleItalic">P</span></span><.05). Infection due to GABHS is also more frequent among those who have or had a history of fever (23.6% vs 16.7%) and among those with tonsillopharyngeal exudate (22.8% vs 16.7%). However, no statistically significant differences were observed in these 2 cases (Figure 2). Table 2 describes the validity of the Centor criteria in the diagnosis of pharyngitis due to GABHS.</p><p class="elsevierStylePara"><img src="27v40n10-13127243fig04.jpg"></img></p><p class="elsevierStylePara"><span class="elsevierStyleBold">FIGURE 2</span> Confirmed group A beta-haemolytic Streptococcus infection according to the presence or absence of Centor criteria.</p><p class="elsevierStylePara"><img src="27v40n10-13127243fig05.jpg"></img></p><p class="elsevierStylePara">The RAT was positive in 48 cases and negative in the remaining 134 determinations (Table 3). The sensitivity observed with this technique was 0.95 and the specificity, 0.93. There were 10 false positives and 2 false negatives. The positive predictive value was 0.79 and the negative predictive value, 0.98.</p><p class="elsevierStylePara"><img src="27v40n10-13127243fig06.jpg"></img></p><p class="elsevierStylePara"><span class="elsevierStyleBold"> Discussion</span></p><p class="elsevierStylePara">The sensitivity and specificity achieved (greater than 90%) with the RAT used, along with the high negative predictive value (98.5% in our study), make this test a very helpful diagnostic tool for the family doctor. Before discussing the results we should mention the points where our study differs compared to others. We have included patients with clinical symptoms of pharyngitis with a suspected streptococcal aetiology; that is to say, those with 2 or more of the Centor criteria. Even so, the observed incidence of GABHS was 22%. In other studies published in this journal, the inclusion criteria were wider, and this, without a doubt, is one of the reasons for having found more favourable results in our study.<span class="elsevierStyleSup">11-13</span></p><p class="elsevierStylePara">Only the study by Díaz-Berenguer showed validity values similar to ours, although the positive predictive value of the RAT was somewhat lower in that one, which was due to a lower prevalence of GABHS.<span class="elsevierStyleSup">12</span></p><p class="elsevierStylePara">It would be wrong to compare the results of current RAT with those obtained at the beginning of the 1990´s, since the current RAT kits are more sensitive. Neither can the microbiology study be compared, as, for example, in the study by Díaz-Berenguer, bacitracin disks were used, and also because this method is not used nowadays, as it produced a high rate of false negatives.<span class="elsevierStyleSup">12</span></p><p class="elsevierStylePara">Another of the conclusions of our study, already documented in other studies, is the low reliability of the clinical criteria for the diagnosis of streptococcal pharyngitis.</p><p class="elsevierStylePara">Even among patients with all the Centor criteria, the probability of having a streptococcal infection was less than 40%. In our study, the presence of any of these criteria makes a streptococcal aetiology more likely, as has been observed in other studies, and of these criteria, the fundamental ones are painful laterocervical lymph nodes and absence of cough.<span class="elsevierStyleSup">11,12,14</span> Only these criteria were significantly more prevalent among patients with GABHS infection. On the other hand, no statistically significant differences have been seen with the presence of an exudate or with the presence of a fever. This same data have been observed in other studies. In the study by Lindæk et al, the prevalence of GABHS was even higher among patients who did not have an exudate.<span class="elsevierStyleSup">14</span></p><p class="elsevierStylePara">In a study recently published in this journal by Marin et al,<span class="elsevierStyleSup">13</span> it mentioned that the clinical score system obtained a higher negative predictive value and a specificity that allowed nonstreptococcal pharyngitis to be diagnosed with sufficient certainty. However, in our study the probability of infection due to another microorganism other than GABHS was greater than 60% among patients who had 4 criteria and over 70% among those who had 3 criteria. The use of clinical criteria to rule out streptococcal pharyngitis may be useful in developing countries, but in these cases it has been seen that the combination of other criteria, besides the Centor, may be more useful.<span class="elsevierStyleSup">15</span> However, in Spain, with the very significant use of antibiotics to treat this infection, it is essential to change habits and use RATs. Only in this way will a reduction in antibiotic prescriptions be achieved, just as was observed in a clinical trial carried out in Canada.<span class="elsevierStyleSup">16</span></p><p class="elsevierStylePara">One aspect of great concern to the doctor who sees a patient with supposedly streptococcal pharyngitis is the reliability of the negative result. In our study, the doctors were free to use antibiotic treatment regardless of the RAT result. The guides indicate that if results are found to be negative, particularly in pharyngitis with all the Centor criteria, they should be confirmed by means of a culture.<span class="elsevierStyleSup">6</span> However, this practice is not usually implemented, since the result takes between 24 and 48 hours. In our study, only 2 patients with a negative result (the 2 cases with 3 Centor criteria) actually had a GABHS infection. Also, in another study carried out in Spain, the usefulness of RAT has also been shown, up to the point of considering the culture unnecessary in negative cases.<span class="elsevierStyleSup">17</span> Mostov,<span class="elsevierStyleSup">18</span> in a recent review, does not recommend it either. A line of research that could be followed in the future is the high observed incidence of infections due to group C beta-haemolytic <span class="elsevierStyleItalic"><span class="elsevierStyleItalic"> Streptococcus</span></span>, 14.3% in our country. The pathogenic role of this bacteria is currently being discussed, since Zwart et al<span class="elsevierStyleSup">19</span> observed that penicillin could reduce, although marginally, the duration of the symptoms of pharyngitis due to group C beta-haemolytic <span class="elsevierStyleItalic"><span class="elsevierStyleItalic"> Streptococcus</span></span>. It has virulence factors similar to those of <span class="elsevierStyleItalic"><span class="elsevierStyleItalic">S pyogenes</span></span> and could cause the same type of infections. It has been associated with outbreaks of pharyngitis with a clinical picture similar to that produced by GABHS, but the non-suppurative after effects are much less common.</p><p class="elsevierStylePara">In conclusion, we believe that all primary care centres should be provided with RAT for the diagnosis of GABHS infections. RAT is easy to perform, it requires no technical support or specialist staff and is rapid. A RAT determination cost between 2 and 3 euros depending on the different manufacturers, a price that is offset by the cost of a box of amoxicillin, penicillin V, or amoxicillinclavulanic acid. Anyway, this not so much an economic problem than one of health care quality.</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Acknowledgement</span></p><p class="elsevierStylePara">We would like to thank Laboratorio Leti for its generosity in providing the Genzyme OSOM StrepA strips free of charge, whenever we needed them for the smooth running of this study.</p><p class="elsevierStylePara"><span class="elsevierStyleBold">What Is Known About the Subject</span><br></br> • <span class="elsevierStyleBold"><span class="elsevierStyleSup"> Beta-haemolytic</span></span><span class="elsevierStyleItalic"><span class="elsevierStyleBold"><span class="elsevierStyleSup">Streptococcus</span></span></span><span class="elsevierStyleBold">is the cause of 15%-25% of acute pharyngotonsillitis in adults and its incidence increases the more Centor criteria the patient has: tonsillar/pharyngeal exudate, history or presence of fever, absence of cough, and/or presence of painful lateral-cervical lymph nodes.<br></br></span>• <span class="elsevierStyleBold">The use of clinical criteria to diagnose streptococcal pharyngitis is of no use. Even in patients with all the Centor criteria the incidence of streptococcal pharyngitis is less than 50%.</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">What This Study Contributes<br></br></span>•<span class="elsevierStyleBold"><span class="elsevierStyleBold"></span></span><span class="elsevierStyleBold"><span class="elsevierStyleBold">The rapid antigen technique is an ideal method for diagnosing pharyngitis due to</span></span><span class="elsevierStyleBold"><span class="elsevierStyleItalic"><span class="elsevierStyleBold">S pyogenes</span></span></span><span class="elsevierStyleBold"><span class="elsevierStyleBold">in the community, since its determination is easy and rapid, and has a sensitivity and specificity of over 90%.<br></br></span></span>•<span class="elsevierStyleBold"><span class="elsevierStyleBold"></span></span><span class="elsevierStyleBold"><span class="elsevierStyleBold">The high negative predictive value of the rapid antigen technique (with a negative result aetiology due to GABHS is ruled out) means there is no need to carry out a subsequent culture.<br></br></span></span>•<span class="elsevierStyleBold"><span class="elsevierStyleBold"></span></span><span class="elsevierStyleBold"><span class="elsevierStyleBold">The use of these rapid antigen techniques should be taken considered, particularly in patients with more than 2 Centor criteria.<br></br></span></span>•<span class="elsevierStyleBold"><span class="elsevierStyleBold"></span></span><span class="elsevierStyleBold"><span class="elsevierStyleBold">The incidence of pharyngitis caused by Group C beta-haemolytic</span></span><span class="elsevierStyleBold"><span class="elsevierStyleItalic"><span class="elsevierStyleBold"> Streptococcus</span></span></span><span class="elsevierStyleBold"><span class="elsevierStyleBold">, around 15% in our population, opens an interesting line of investigation, since there is currently no clear consensus on its treatment.</span></span></p><p class="elsevierStylePara">Spanish version available <span class="elsevierStyleBold"><span class="elsevierStyleBold"><a href="http://www.elsevier.es/270.210" class="elsevierStyleCrossRefs">www.elsevier.es/270.210</a><br></br></span></span> A commentary follow this article (page. 495)</p><hr></hr><p class="elsevierStylePara"> Correspondence: C. Llor. Foixarda, 95. 43008 Tarragona. España.<br></br> E-mail: <a href="mailto:carles.llor@urv.cat" class="elsevierStyleCrossRefs"> carles.llor@urv.cat</a></p><p class="elsevierStylePara">Manuscript received March 26, 2008.<br></br> Accepted for publication April 28, 2008.</p>" "pdfFichero" => "27v40n10a13127243pdf001.pdf" "tienePdf" => true "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec689927" "palabras" => array:4 [ 0 => "Faringitis" 1 => "Streptococcus pyogenes" 2 => "Técnica antigénica rápida" 3 => "Estreptococo betahemolítico del grupo A" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec689926" "palabras" => array:4 [ 0 => "Pharyngitis" 1 => "Streptococcus pyogenes" 2 => "Rapid antigen test" 3 => "Group A beta-haemolytic Streptococcus" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:1 [ "resumen" => "Objective. To determine the validity of the rapid antigen test (RAT) OSOM StrepA Genzyme for the diagnosis of acute pharyngitis caused by group A beta-haemolytic strep (GABHS). Design. Diagnostic techniques survey. Setting. Urban primary care centre, Spain. Participants. All patients over 14 years old seen in 6 surgeries with sore throat and 2 or more Centor criteria: pharyngotonsillar exudate, tender laterocervical nodes, absence of coughing, and/or history or presence of fever. Principal measurements. Pharyngeal swabs were taken from all the patients, one for RAT and another to send for culture in the microbiology department. Results. A total of 182 patients were evaluable, with a mean age of 30.6 (12.1) years of which 116 were women (63.7%); 63 patients had 2 Centor criteria; 83 had 3 and 36, the 4 criteria. The culture was positive in 102 patients (56%), with GABHS showing infection in forty (22%; 95% confidence interval [CI], 21.2-22.8). Group C Streptococcus was isolated in 26 patients (14.3%). GABHS was higher among patients with four Centor criteria (38.9% vs 25.3% observed among those with 3 criteria and 7.9% with 2 criteria; P<.001). Sensitivity of RAT was 95%, with a specificity of 93%, a positive predictive value of 79.2% and a negative predictive value of 98.5%. Conclusions. These results show the usefulness of RAT for diagnosing streptococcal pharyngitis. Its use should be spread to all primary care practices." ] "es" => array:1 [ "resumen" => "Objetivo. Determinamos la validez de la técnica antigénica rápida (TAR) OSOM StrepA Genzyme en el diagnóstico de la faringitis aguda causada por estreptococo betahemolítico del grupo A (EBHGA). Diseño. Estudio de pruebas diagnósticas. Emplazamiento. Equipo urbano de atención primaria. Participantes. Todos los pacientes mayores de 14 años atendidos en 6 consultas con síntomas de odinofagia y 2 o más de los criterios de Centor (exudado faringoamigdalar, adenopatías laterocervicales dolorosas, ausencia de tos y/o historia o presencia de fiebre). Mediciones principales. A todos los pacientes se les tomó una muestra faringoamigdalar con 2 hisopos, uno para TAR y otro que fue remitido al servicio de microbiología para realizar cultivo. Resultados. Fueron evaluables 182 sujetos, con una edad media de 30,6 ± 12,1 años, 116 mujeres (63,7%). Presentaron 2, 3 y 4 criterios de Centor 63, 83 y 36 sujetos, respectivamente. El cultivo fue positivo en 102 casos (56%), observándose infección por EBHGA en 40 pacientes (22%; intervalo de confianza [IC] del 95%, 21,2-22,8); en 26 casos se aisló estreptococo del grupo C (14,3%). La infección por EBHGA presentó una mayor prevalencia entre los pacientes con 4 criterios (un 38,9% frente a un 25,3% observado con 3 criterios y frente al 7,9% con 2 criterios; p < 0,001). La TAR tuvo una sensibilidad del 95%, una especificidad del 93%, un valor predictivo positivo del 79,2% y un valor predictivo negativo del 98,5%. Conclusiones. Estos resultados demuestran la utilidad de la TAR para el diagnóstico de la faringitis estreptocócica. Su uso debería extenderse a todas las consultas de atención primaria." ] ] "multimedia" => array:12 [ 0 => array:7 [ "identificador" => "fig1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "27v40n10-13127243fig01.jpg" "Alto" => 1583 "Ancho" => 995 "Tamanyo" => 221651 ] ] "descripcion" => array:1 [ "en" => "General Scheme of the Study. Prospective, observational study, carried out between January 2007 and March 2008. *One patient had nausea during the procedure, although the 2 swabs could be collected.GABHS indicates group A beta-haemolytic Streptococcus." ] ] 1 => array:8 [ "identificador" => "tbl1" "etiqueta" => "TABLE 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:1 [ "tablaImagen" => array:1 [ 0 => array:4 [ "imagenFichero" => "27v40n10-13127243fig02.jpg" "imagenAlto" => 708 "imagenAncho" => 1466 "imagenTamanyo" => 171254 ] ] ] ] ] "descripcion" => array:1 [ "en" => "Aetiology Observed According to the Number of Centor Criteria" ] ] 2 => array:8 [ "identificador" => "fig2" "etiqueta" => "FIGURE 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "27v40n10-13127243fig03.jpg" "Alto" => 820 "Ancho" => 1387 "Tamanyo" => 67220 ] ] "descripcion" => array:1 [ "en" => "Aetiology observed in the pharyngeal cultures." ] ] 3 => array:8 [ "identificador" => "fig3" "etiqueta" => "FIGURE 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "27v40n10-13127243fig04.jpg" "Alto" => 941 "Ancho" => 1375 "Tamanyo" => 59420 ] ] "descripcion" => array:1 [ "en" => "Confirmed group A beta-haemolytic Streptococcus infection according to the presence or absence of Centor criteria." ] ] 4 => array:8 [ "identificador" => "tbl2" "etiqueta" => "TABLE 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:1 [ "tablaImagen" => array:1 [ 0 => array:4 [ "imagenFichero" => "27v40n10-13127243fig05.jpg" "imagenAlto" => 441 "imagenAncho" => 1445 "imagenTamanyo" => 112474 ] ] ] ] ] "descripcion" => array:1 [ "en" => "Sensitivity, Specificity, Positive Predictive Value, and Negative Predictive Value of Centor Criteria in the Diagnosis of Pharyngitis Due to Group A Beta-Haemolytic Streptococcus" ] ] 5 => array:8 [ "identificador" => "tbl3" "etiqueta" => "TABLE 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:1 [ "tablaImagen" => array:1 [ 0 => array:4 [ "imagenFichero" => "27v40n10-13127243fig06.jpg" "imagenAlto" => 504 "imagenAncho" => 995 "imagenTamanyo" => 78235 ] ] ] ] ] "descripcion" => array:1 [ "en" => "Relationship Between the Results of the Rapid Antigen Technique and the Pharyngeal Culture" ] ] 6 => array:5 [ "identificador" => "fig4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" ] 7 => array:5 [ "identificador" => "fig5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" ] 8 => array:5 [ "identificador" => "fig6" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" ] 9 => array:5 [ "identificador" => "fig7" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" ] 10 => array:5 [ "identificador" => "fig8" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" ] 11 => array:5 [ "identificador" => "fig9" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" ] ] "bibliografia" => array:2 [ "titulo" => "Bibliography" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:19 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Estudio de las infecciones respiratorias extrahospitalarias. Estudio DIRA. Enferm Infecc Microbiol Clin. 2003;21:410-6." "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Estudio de las infecciones respiratorias extrahospitalarias. Estudio DIRA." "idioma" => "es" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "Picazo JJ" 1 => "Pérez-Cecilia E" 2 => "Herreras A" 3 => "Grupo DIRA en Atención Primaria." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Enferm Infecc Microbiol Clin" "fecha" => "2003" "volumen" => "21" "paginaInicial" => "410" "paginaFinal" => "6" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14525706" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Documento de consenso sobre tratamiento antimicrobiano de la faringoamigdalitis. Acta Otorrinolaringol Esp. 2003;54:369-83." "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Documento de consenso sobre tratamiento antimicrobiano de la faringoamigdalitis." "idioma" => "es" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:7 [ 0 => "Cenjor C" 1 => "García-Rodríguez JA" 2 => "Ramos A" 3 => "Cervera J" 4 => "Tomás M" 5 => "Asensi F" 6 => "et al." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Acta Otorrinolaringol Esp" "fecha" => "2003" "volumen" => "54" "paginaInicial" => "369" "paginaFinal" => "83" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12916480" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib3" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Adecuación del tratamiento de la faringoamigdalitis aguda a la evidencia científica. An Pediatr (Barc). 2003;59:31-40." "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Adecuación del tratamiento de la faringoamigdalitis aguda a la evidencia científica." "idioma" => "es" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "Ochoa C" 1 => "Vilela M" 2 => "Cueto M" 3 => "Eiros JM" 4 => "Inglada L y el Grupo Español de Estudio de los Tratamientos Antibióticos." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "An Pediatr (Barc)" "fecha" => "2003" "volumen" => "59" "paginaInicial" => "31" "paginaFinal" => "40" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib4" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Short-course treatment for acute tonsillopharyngitis. Int J Antimicrob Agents. 2000;16:495-7." "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Short-course treatment for acute tonsillopharyngitis." "idioma" => "en" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "Esposito S" 1 => "Ascione T." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Int J Antimicrob Agents" "fecha" => "2000" "volumen" => "16" "paginaInicial" => "495" "paginaFinal" => "7" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11118866" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib5" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Antibiotics for sore throat (Cochrane review). Cochrane Database Syst Rev. 2006;4: CD000023." "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Antibiotics for sore throat (Cochrane review)." "idioma" => "en" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "del Mar CB" 1 => "Glasziou PP" 2 => "Spinks AB." ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/14651858.CD000023.pub3" "Revista" => array:5 [ "tituloSerie" => "Cochrane Database Syst Rev" "fecha" => "2006" "volumen" => "4" "paginaInicial" => "CD000023" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17054126" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib6" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "referenciaCompleta" => "Report of the Committee on Infectious Diseases. 27th ed. Elk Grove Village: American Academy of Paediatrics; 2006." "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Report of the Committee on Infectious Diseases. 27th ed. Elk Grove Village: American Academy of Paediatrics; 2006." "idioma" => "en" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "American Academy of Paediatric.s" 1 => "Red Book." ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib7" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "¿Dónde está la fiebre reumática? Med Clin (Barc). 1987;88:61-4." "contribucion" => array:1 [ 0 => array:1 [ "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "Batlle E." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "¿Dónde está la fiebre reumática? Med Clin (Barc)" "fecha" => "1987" "volumen" => "88" "paginaInicial" => "61" "paginaFinal" => "4" ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib8" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Protective effect of antibiotics against serious complications of common respiratory tract infections: retrospective cohort study with the UK General Practice Research Database. BMJ. 2007;335:982." "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Protective effect of antibiotics against serious complications of common respiratory tract infections: retrospective cohort study with the UK General Practice Research Database." "idioma" => "en" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "Petersen I" 1 => "Johnson AM" 2 => "Islam A" 3 => "Duckworth G" 4 => "Livermore DM" 5 => "Hayward AC." ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/bmj.39345.405243.BE" "Revista" => array:5 [ "tituloSerie" => "BMJ" "fecha" => "2007" "volumen" => "335" "paginaInicial" => "982" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17947744" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib9" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "The diagnosis of strep throat in adults in the emergency room. Med Decis Making. 1981;1:239-46." "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "The diagnosis of strep throat in adults in the emergency room." "idioma" => "en" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "Centor RM" 1 => "Witherspoon JM" 2 => "Dalton HP" 3 => "Brody CE" 4 => "Link K." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Med Decis Making" "fecha" => "1981" "volumen" => "1" "paginaInicial" => "239" "paginaFinal" => "46" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6763125" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib10" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "The validity of a sore throat score in family practice. CMAJ. 2000;163:811-5." "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "The validity of a sore throat score in family practice." "idioma" => "en" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "McIsaac WJ" 1 => "Goel V" 2 => "To T" 3 => "Low DE." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "CMAJ" "fecha" => "2000" "volumen" => "163" "paginaInicial" => "811" "paginaFinal" => "5" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11033707" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib11" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Evaluación de los datos clínicos y de una técnica antigénica rápida (TestPack Strep A) en el diagnóstico de las faringoamigdalitis agudas estreptocócicas. Aten Primaria. 1991; 8:92-8." "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Evaluación de los datos clínicos y de una técnica antigénica rápida (TestPack Strep A) en el diagnóstico de las faringoamigdalitis agudas estreptocócicas." "idioma" => "es" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:7 [ 0 => "Bladé J" 1 => "Alamán E" 2 => "Cartañà A" 3 => "Guinea I" 4 => "Liberal A" 5 => "Herreros M" 6 => "et al." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Aten Primaria" "fecha" => "1991" "volumen" => "8" "paginaInicial" => "92" "paginaFinal" => "8" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1893053" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib12" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Evaluación de una técnica antigénica rápida de detección del antígeno estreptocócico tipo A (Test Pack Strep A®). Aten Primaria. 1992;9:245-9." "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Evaluación de una técnica antigénica rápida de detección del antígeno estreptocócico tipo A (Test Pack Strep A®)." "idioma" => "es" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "Díaz-Berenguer JA" 1 => "Ibrahim F." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Aten Primaria" "fecha" => "1992" "volumen" => "9" "paginaInicial" => "245" "paginaFinal" => "9" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1498218" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib13" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "¿Es posible el diagnóstico clínico de la faringoamigdalitis estreptocócica? Aten Primaria. 2007;39:361-5." "contribucion" => array:1 [ 0 => array:1 [ "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "Marín J" 1 => "Cubillo A" 2 => "Gómez-Escalonilla N" 3 => "Garzón de la Iglesia J" 4 => "Reyes MN." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "¿Es posible el diagnóstico clínico de la faringoamigdalitis estreptocócica? Aten Primaria" "fecha" => "2007" "volumen" => "39" "paginaInicial" => "361" "paginaFinal" => "5" ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib14" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Clinical symptoms and signs in sore throat patients with large colony variant b-haemolytic streptococci groups C or G versus group A. Br J Gen Pract. 2005;55:615-9." "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Clinical symptoms and signs in sore throat patients with large colony variant b-haemolytic streptococci groups C or G versus group A." "idioma" => "en" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "Lindbæk M" 1 => "Hfiby EA" 2 => "Lermark G" 3 => "Steinsholdt IM" 4 => "Hjortdahl P." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Br J Gen Pract" "fecha" => "2005" "volumen" => "55" "paginaInicial" => "615" "paginaFinal" => "9" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16105370" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib15" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Pharyngitis in low-resources settings: a pragmatic clinical approach to reduce unnecessary antibiotic use. Pediatrics. 2006;118:e1607-11." "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Pharyngitis in low-resources settings: a pragmatic clinical approach to reduce unnecessary antibiotic use." "idioma" => "en" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "Smeesters PR" 1 => "Campos D" 2 => "van Melderen L" 3 => "de Aguilar E" 4 => "Vanderpas J" 5 => "Verglson A." ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1542/peds.2006-1025" "Revista" => array:6 [ "tituloSerie" => "Pediatrics" "fecha" => "2006" "volumen" => "118" "paginaInicial" => "e1607" "paginaFinal" => "11" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17142490" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib16" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Diagnosing streptococcal sore throat in adults. Randomized controlled trial of in-office aids. Can Fam Phys. 2007;53:666-71." "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Diagnosing streptococcal sore throat in adults. Randomized controlled trial of in-office aids." "idioma" => "en" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "Worall G" 1 => "Hutchinson J" 2 => "Sherman G" 3 => "Griffiths J." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Can Fam Phys" "fecha" => "2007" "volumen" => "53" "paginaInicial" => "666" "paginaFinal" => "71" ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib17" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Empleo racional de los antibióticos en pediatría: impacto de la aplicación de un test rápido de detección de estreptococo beta-hemolítico del grupo A en la faringoamigdalitis aguda. An Esp Pediatr. 2000;52:212-9." "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Empleo racional de los antibióticos en pediatría: impacto de la aplicación de un test rápido de detección de estreptococo beta-hemolítico del grupo A en la faringoamigdalitis aguda." "idioma" => "es" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "Contessotto C" 1 => "Cámara M" 2 => "Avilés MJ" 3 => "Ojeda JM" 4 => "Cascales I" 5 => "Rodríguez F." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "An Esp Pediatr" "fecha" => "2000" "volumen" => "52" "paginaInicial" => "212" "paginaFinal" => "9" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11003896" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib18" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Treating the immunocompetent patient who presents with an upper respiratory infection: pharyngitis, sinusitis and bronchitis. Prim Care Clin Office Pract. 2007;34:39-58." "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Treating the immunocompetent patient who presents with an upper respiratory infection: pharyngitis, sinusitis and bronchitis." "idioma" => "en" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "Mostov PD." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Prim Care Clin Office Pract" "fecha" => "2007" "volumen" => "34" "paginaInicial" => "39" "paginaFinal" => "58" ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib19" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Penicillin for acute sore throat: randomized double blind trial of seven days versus three days treatment or placebo in adults. BMJ. 2000;320:150-4." "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Penicillin for acute sore throat: randomized double blind trial of seven days versus three days treatment or placebo in adults." "idioma" => "en" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "Zwart S" 1 => "Sachs AP" 2 => "Ruijs GJ" 3 => "Gubbels JW" 4 => "Hoes AW" 5 => "de Melker RA." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "BMJ" "fecha" => "2000" "volumen" => "320" "paginaInicial" => "150" "paginaFinal" => "4" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10634735" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/02126567/0000004000000010/v0_201607111213/13127243/v0_201607111214/en/main.assets" "Apartado" => array:4 [ "identificador" => "14695" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Originales" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/02126567/0000004000000010/v0_201607111213/13127243/v0_201607111214/en/27v40n10a13127243pdf001.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/13127243?idApp=UINPBA00004N" ]
Article information
ISSN: 02126567Original language: English
DOI:10.1157/13127228
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