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Eventos adversos evitables en atención primaria. Estudio retrospectivo de cohortes para determinar su frecuencia y gravedad
Avoidable adverse events in primary care. Retrospective cohort study to determine their frequency and severity
Irene Carrilloa,b, José Joaquín Miraa,c,
Autor para correspondencia
jose.mira@umh.es

Autor para correspondencia.
, M. Pilar Astier-Peñad, Pastora Pérez-Péreze, Johanna Caro-Mendivelsof, Guadalupe Oliverag, Carmen Silvestreh, Aurora Mulab, María Ángeles Nuini, Jesús M. Aranaz-Andrésj,k, en nombre del Grupo SOBRINA
a Universidad Miguel Hernández de Elche, Elche, Alicante, España
b Fundació per al Foment de la Investigació Sanitària i Biomèdica de la Comunitat Valenciana (FISABIO), Elche, Alicante, España
c Centro de Salud Hospital Provincial-Pla, Departamento de Salud Alicante - Sant Joan D’Alacant, San Juan, Alicante, España
d Centro de Salud La Jota, Servicio Aragonés de Salud, Zaragoza, España
e Observatorio para la Seguridad del Paciente, Agencia de Calidad Sanitaria de Andalucía, Sevilla, España
f Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS), Barcelona, España
g Hospital Clínico San Carlos, Servicio Madrileño de Salud, Madrid, España
h Servicio de Efectividad y Seguridad Asistencial, Servicio Navarro de Salud-Osasunbidea, Pamplona, España
i Instituto de Salud Pública y Laboral de Navarra, Pamplona, España
j Servicio de Medicina Preventiva y Salud Pública, Hospital Universitario Ramón y Cajal, Madrid, España
k Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, España
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Recientes estudios han puesto de manifiesto que&#44; en estos a&#241;os&#44; no se ha logrado una reducci&#243;n significativa de su n&#250;mero<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">4&#8211;6</span></a>&#46; Esto puede ser debido&#44; en parte&#44; a que ahora medimos con mayor exhaustividad que hace unos a&#241;os&#44; a que somos m&#225;s conscientes del problema y&#44; tambi&#233;n&#44; a que comprendemos mejor la naturaleza de los EA&#44; incluidos los que tienen causas m&#225;s complejas de detectar<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">7</span></a> &#40;por ejemplo&#44; evoluci&#243;n t&#243;rpida de un paciente diab&#233;tico tras muchos a&#241;os con un inadecuado seguimiento de la hemoglobina glucosilada&#44; HbA1c&#41;&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">En atenci&#243;n primaria &#40;AP&#41; un 12&#44;6&#37; de los pacientes &#40;rango entre 2&#44;3 y un 26&#44;5&#37;&#41;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">8</span></a> sufrieron un incidente de seguridad &#40;que podr&#237;a haber causado o que le caus&#243; 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el 70&#37; evitables&#46; Al extrapolar estos datos se llegaba a la conclusi&#243;n de que cada m&#233;dico de familia se ve&#237;a implicado en 6 EA cada a&#241;o<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">18</span></a>&#46; En nuestro pa&#237;s no se ha vuelto a medir la frecuencia de EA en este nivel asistencial&#46; El objetivo de este estudio fue determinar la frecuencia de eventos adversos evitables &#40;EAE&#41; en AP&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Material y m&#233;todos</span><p id="par0035" class="elsevierStylePara elsevierViewall">Entre abril y septiembre de 2019 se llev&#243; a cabo un estudio retrospectivo de cohortes en el que un total de 25 profesionales &#40;20 m&#233;dicos de familia y 5 pediatras&#41; revisaron una selecci&#243;n aleatoria de historias cl&#237;nicas electr&#243;nicas de pacientes atendidos en AP en centros de salud de Andaluc&#237;a&#44; Arag&#243;n&#44; Castilla La Mancha&#44; Catalu&#241;a&#44; Madrid&#44; Navarra y Comunidad Valenciana&#46; La gu&#237;a STROBE<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">19</span></a> para estudios de cohortes se adopt&#243; como referencia para este estudio&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Definiciones</span><p id="par0040" class="elsevierStylePara elsevierViewall">EA fue definido como da&#241;o inesperado e involuntario que sufre un paciente en el curso de la atenci&#243;n que recibe y que no guarda relaci&#243;n con su enfermedad de base<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">20</span></a>&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">EAE es aquel que ocurre como resultado de una causa identificable y modificable o bien cuando el da&#241;o podr&#237;a prevenirse con cambios en el proceso asistencial y el seguimiento de gu&#237;as de pr&#225;ctica o de las recomendaciones No Hacer elaboradas por las sociedades cient&#237;ficas<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">21</span></a>&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Per&#237;odo de revisi&#243;n</span><p id="par0050" class="elsevierStylePara elsevierViewall">En la revisi&#243;n de historias cl&#237;nicas se contabiliz&#243; la ocurrencia de nuevos EAE ocurridos en el per&#237;odo desde el 1 de febrero de 2018 hasta el momento de realizar la revisi&#243;n y codificaci&#243;n de datos &#40;septiembre de 2019&#41;&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Tama&#241;o muestral</span><p id="par0055" class="elsevierStylePara elsevierViewall">Para un nivel de confianza del 95&#37; y una precisi&#243;n &#40;error esperado&#41; del 2&#37;&#44; se consider&#243; necesario revisar un m&#237;nimo de 2397 historias cl&#237;nicas&#46; La muestra se estratific&#243;&#44; considerando la frecuentaci&#243;n por grupos de edad de la siguiente forma&#58; 30-45 a&#241;os &#40;11&#44;0&#37;&#41;&#44; 46-64 &#40;13&#44;0&#37;&#41;&#44; 65-74 &#40;52&#44;6&#37;&#41;&#44; 75-80 &#40;14&#44;3&#37;&#41; y &#62; 80 a&#241;os &#40;9&#44;1&#37;&#41; en personas adultas y 3-12 meses &#40;35&#44;2&#37;&#41;&#44; 2-5 a&#241;os &#40;35&#44;2&#37;&#41; y 6-12 &#40;29&#44;6&#37;&#41; en menores&#46; En todos los grupos de edad la selecci&#243;n de historias de hombres&#47;ni&#241;os y mujeres&#47;ni&#241;as fue paritaria&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Procedimiento</span><p id="par0060" class="elsevierStylePara elsevierViewall">La revisi&#243;n se apoy&#243; en una herramienta online tipo &#8220;trigger tool&#8221;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">22</span></a> que focalizaba la atenci&#243;n del revisor en da&#241;os evitables en tratamientos y procedimientos frecuentes en AP&#44; en consonancia con la recomendaci&#243;n de Amalberti et al<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">7</span></a>&#44; identificando el tipo de da&#241;o que podr&#237;a producirse&#46; Esta herramienta se elabor&#243; siguiendo las recomendaciones del Institute for Healthcare Improvement &#40;IHI&#41; &#8220;Global Trigger Tool for Measuring Adverse Events&#8221;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">23</span></a> por consenso entre 25 profesionales de AP&#46; Para cada EAE identificado se especificaba una breve descripci&#243;n del mismo&#44; la naturaleza del da&#241;o &#40;relacionado con la asistencia sanitaria&#44; con procedimientos y cuidados&#44; con la medicaci&#243;n u otros&#41; y su gravedad&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">La gravedad del EAE para el paciente se valor&#243; por los revisores en una escala adaptada de Woods et al<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">24</span></a>&#44; de 8 pasos &#40;0&#58; sin da&#241;o&#44; 1&#58; da&#241;o emocional&#44; 2&#58; da&#241;o f&#237;sico insignificante&#44; 3&#58; da&#241;o leve temporal&#44; 4&#58; da&#241;o grave temporal&#44; 5&#58; da&#241;o leve permanente&#44; 6&#58; da&#241;o grave permanente&#44; and 7&#58; muerte&#41;&#46; Se han registrado como EAE aquellos incidentes valorados con valores de 3 o superior&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Se control&#243; el grado de acuerdo &#40;Kappa de Cohen<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">25</span></a>&#41; entre revisores en una selecci&#243;n aleatoria de historias cl&#237;nicas&#46; En cada nodo del estudio los revisores contaron con una coordinadora que&#44; en los casos dudosos&#44; consensu&#243; con el revisor c&#243;mo codificar la informaci&#243;n&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">An&#225;lisis estad&#237;stico</span><p id="par0075" class="elsevierStylePara elsevierViewall">Se estimaron las frecuencias absolutas de EAE por cada 100 historias cl&#237;nicas de pacientes del m&#233;dico de familia o del pediatra&#46; Se calcularon la tasa cruda y&#44; considerando las diferencias en frecuentaci&#243;n de hombre y mujeres&#44; la tasa ajustada por grupos de edad y sexo utilizando como poblaci&#243;n de referencia los datos de frecuentaci&#243;n de 2018&#44; aportados por la aplicaci&#243;n Interactiva del sistema de Informaci&#243;n de Atenci&#243;n Primaria &#40;SIAP&#41; del Ministerio de Sanidad Consumo y Bienestar Social<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">26</span></a>&#46; Se aplic&#243; Chi-Cuadrado con correcci&#243;n de Yates para comparar la frecuencia de EAE entre hombres&#47;ni&#241;os y mujeres&#47;ni&#241;as y la prueba de Cochran-Mantel-Haenszel para analizar las diferencias en la tasa ajustada entre ambos sexos&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">&#201;tica investigaci&#243;n</span><p id="par0080" class="elsevierStylePara elsevierViewall">Este estudio fue aprobado por el Comit&#233; &#201;tico de Investigaci&#243;n Cl&#237;nica Corporativo de Atenci&#243;n Primaria de la Comunidad Valenciana&#44; la Comisi&#243;n Central de Investigaci&#243;n de la Gerencia Asistencial de Atenci&#243;n Primaria de Madrid y el Comit&#233; de &#201;tica de la Investigaci&#243;n con Medicamentos del Gobierno de Navarra&#46; La Agencia Espa&#241;ola del Medicamento y Productos Sanitarios &#40;AEMPS&#41; clasific&#243; este estudio como Observacional No Postautorizaci&#243;n &#40;No-EPA&#41;&#46;<elsevierMultimedia ident="fig0005"></elsevierMultimedia></p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Resultados</span><p id="par0085" class="elsevierStylePara elsevierViewall">Se revis&#243; un total de 2557 historias cl&#237;nicas &#40;1928&#44; 75&#44;4&#37;&#44; de pacientes adultos y 629&#44; 24&#44;6&#37;&#44; pedi&#225;tricos&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46; El rango de historias cl&#237;nicas revisadas por cada revisor oscil&#243; entre 77 y 154&#46; En total se identificaron 215 incidentes&#44; 175 en pacientes adultos y 40 en pedi&#225;tricos&#46; De estos incidentes 32 fueron clasificados como causantes de da&#241;o emocional o insignificante y no se incluyeron en el an&#225;lisis&#46; En el an&#225;lisis de la concordancia entre pares&#44; al comparar el resultado de la revisi&#243;n de las mismas historias cl&#237;nicas&#44; se observ&#243; que solo en un caso el grado de acuerdo fue sustancial &#40;Kappa &#62; 0&#44;60&#41; y&#44; en el resto&#44; fue casi perfecto &#40;Kappa &#62; 0&#44;80&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Frecuencia de EAE</span><p id="par0090" class="elsevierStylePara elsevierViewall">En total se registraron 182 EAE que afectaron a 168 pacientes&#44; 134 pacientes adultos y 34 pedi&#225;tricos&#46; 12 pacientes sufrieron m&#225;s de un EA&#46; La frecuencia de EAE&#44; en el conjunto del per&#237;odo de dos a&#241;os&#44; por paciente con historia cl&#237;nica abierta en AP fue del 7&#44;1&#37; &#40;IC 95&#37; 6&#44;1&#37;-8&#44;1&#37;&#41;&#46; En el caso de pacientes adultos 7&#44;6&#37; &#40;IC 95&#37; 6&#44;4-8&#44;8&#37;&#41; y del 5&#44;7&#37; &#40;IC 95&#37; 3&#44;9-7&#44;5&#37;&#41; en pacientes pedi&#225;tricos&#46; El n&#250;mero de EAE fue menor en hombres &#40;tasa cruda 5&#44;8&#37; IC95&#37; 4&#44;3-7&#44;4&#37;&#59; tasa ajustada 4&#44;3&#37;&#44; IC 95&#37; 3&#44;9-4&#44;7&#37;&#41; que en mujeres &#40;tasa cruda 9&#44;2&#37; IC95&#37; 7&#44;4-10&#44;9&#37;&#59; tasa ajustada 6&#44;9&#37;&#44; IC 95&#37; 6&#44;4-7&#44;4&#37;&#41; &#40;tasa cruda Chi<span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>8&#44;1&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;004&#59; tasa ajustada Chi<span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>59&#44;8&#44; p &#60; 0&#44;0001&#41;&#46; La frecuencia de EAE en ni&#241;os &#40;tasa cruda 6&#44;7 IC95&#37; 4&#44;0-9&#44;5&#41; y ni&#241;as &#40;tasa cruda 4&#44;7&#37; IC95&#37; 2&#44;4-7&#44;1&#41; fue similar &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;3&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46; La frecuencia de EAE se increment&#243; paulatinamente conforme el paciente era de mayor edad&#44; pasando del 1&#37; a los 30-45 a&#241;os al 15&#44;5&#37; entre los mayores de 80 a&#241;os &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;&#46; Esta tendencia se observ&#243; tanto en hombres como en mujeres&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Gravedad y naturaleza de los EAE</span><p id="par0095" class="elsevierStylePara elsevierViewall">La mayor&#237;a de los EAE fueron leves y sin consecuencias permanentes&#44; tanto en pacientes adultos &#40;95&#44; 65&#44;1&#37;&#41;&#44; como pedi&#225;tricos &#40;36&#44; 100&#37;&#44; 21 en chicos y 15 en chicas&#41;&#46; La gravedad de los EAE fue similar entre hombres y mujeres&#46; 27 &#40;18&#44;5&#37;&#41; EAE supusieron un da&#241;o grave en pacientes adultos&#44; de los cuales 6 &#40;4&#44;1&#37;&#41; fueron permanentes &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a>&#41;&#46; En proporci&#243;n este dato supone que 1 de cada 24 EAE fue grave permanente en el caso de pacientes adultos&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">Tanto en medicina de familia como en pediatr&#237;a&#44; la mayor&#237;a de los EAE identificados estuvieron relacionados con la medicaci&#243;n&#44; siendo menos frecuentes los derivados de procedimientos y la asistencia sanitaria &#40;<a class="elsevierStyleCrossRef" href="#tbl0025">tabla 5</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia></span></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">Discusi&#243;n</span><p id="par0105" class="elsevierStylePara elsevierViewall">Estos resultados ponen de manifiesto que la reducci&#243;n de EAE en AP debe seguir siendo uno de los objetivos de las actuaciones de gestores y cl&#237;nicos&#44; tambi&#233;n en pediatr&#237;a&#46; El hecho de que el da&#241;o que ocasionan sea leve en la mayor&#237;a de los casos&#44; en consonancia con lo apuntado por otros estudios<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">15&#44;27</span></a>&#44; no debe hacernos perder de vista que&#44; uno de cada 22 EAE ha supuesto que el paciente adulto sufra un da&#241;o grave y permanente que deber&#237;a haberse evitado&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Mientras que se confirma que el riesgo de sufrir un EAE aumenta conforme se incrementa la edad del paciente<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">7&#44;9&#44;11&#44;17</span></a>&#44; sorprende que las mujeres tengan un mayor riesgo de sufrir un EAE que los hombres&#46; Este hecho invita a analizar&#44; desde una perspectiva de g&#233;nero&#44; c&#243;mo estilos de pr&#225;ctica profesional en AP<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">28</span></a> inciden en la seguridad&#44; aspecto hasta ahora poco estudiado&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">El estudio APEAS<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">17</span></a> se realiz&#243; en un entorno muy distinto al actual&#44; consider&#243; tanto EA evitables como no evitables y analiz&#243; lo que ocurr&#237;a en consultas&#46; En este estudio&#44; en cambio&#44; la poblaci&#243;n se ha estructurado considerando su frecuentaci&#243;n&#44; lo que ha sobrerrepresentado el n&#250;mero de pacientes de mayor edad&#44; precisamente los de mayor riesgo de sufrir un EA&#46; Adem&#225;s&#44; se han empleado &#8220;triggers&#8221; que dirig&#237;an la b&#250;squeda de informaci&#243;n en las historias&#46; Con estas restricciones en la comparaci&#243;n&#44; podemos considerar que si la frecuentaci&#243;n por paciente en 2018 fue de 4&#44;81 visitas a&#241;o<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">29</span></a> &#40;lo que supone 7&#44;2 visitas en 18 meses&#41;&#44; la frecuencia de EAE por consulta que se deduce de este estudio oscilar&#237;a alrededor del 9&#44;86&#8240;&#44; superior a la de EAE encontrados en el estudio APEAS &#40;7&#44;83&#8240;&#41; y a las cifras aportadas por la revisi&#243;n de Panagioti et al<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">4</span></a> de frecuencia de EAE en AP&#46; Esta diferencia se explicar&#237;a por una combinaci&#243;n de causas&#46; Primero&#44; porque las cifras aportadas por APEAS y otros estudios similares reflejaban&#44; muy probablemente&#44; la &#8220;punta del iceberg&#8221; de la frecuencia de los incidentes para la seguridad<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">30</span></a>&#46; Segundo&#44; porque los &#8220;triggers&#8221; empleados han probablemente contribuido a un mayor registro de incidentes&#46; Tercero&#44; porque las intervenciones para incrementar la seguridad de los pacientes no han sido suficientemente efectivas&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Limitaciones&#46; El dise&#241;o del estudio se centr&#243; en situaciones cl&#237;nicas que sabemos suponen un mayor riesgo de incidentes de seguridad&#46; Se han empleado &#8220;triggers&#8221; por lo que pueden existir otros incidentes con da&#241;o no explorados y&#44; por tanto&#44; no registrados&#46; La calidad del registro de informaci&#243;n en la historia cl&#237;nica condiciona los resultados&#46; Este aspecto no ha sido controlado&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0160">Financiaci&#243;n</span><p id="par0125" class="elsevierStylePara elsevierViewall">Este estudio ha sido financiado por el Instituto de Salud Carlos III y por Fondos FEDER&#44; convocatoria de la Acci&#243;n Estrat&#233;gica en Salud &#91;referencia PI16&#47;00816&#93;&#46;</p></span></span>"
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        8 => array:2 [
          "identificador" => "sec0060"
          "titulo" => "Discusi&#243;n"
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        9 => array:2 [
          "identificador" => "sec0065"
          "titulo" => "Financiaci&#243;n"
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        10 => array:2 [
          "identificador" => "xack603174"
          "titulo" => "Agradecimientos"
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        11 => array:1 [
          "titulo" => "Bibliograf&#237;a"
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    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2019-12-17"
    "fechaAceptado" => "2020-02-04"
    "PalabrasClave" => array:2 [
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        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec1513764"
          "palabras" => array:5 [
            0 => "Seguridad del paciente"
            1 => "Errores m&#233;dicos"
            2 => "Atenci&#243;n Primaria"
            3 => "Calidad asistencial"
            4 => "Estudio de cohortes"
          ]
        ]
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        0 => array:4 [
          "clase" => "keyword"
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          "palabras" => array:5 [
            0 => "Patient safety"
            1 => "Medical errors"
            2 => "Primary Care"
            3 => "Quality assurance"
            4 => "Cohort study"
          ]
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    "resumen" => array:2 [
      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objetivo</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Determinar la frecuencia de eventos adversos evitables &#40;EAE&#41; en atenci&#243;n primaria &#40;AP&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Dise&#241;o</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Estudio retrospectivo de cohortes&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Emplazamiento</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">consultas de medicina de familia y pediatr&#237;a de Andaluc&#237;a&#44; Arag&#243;n&#44; Castilla La Mancha&#44; Catalu&#241;a&#44; Madrid&#44; Navarra y Comunidad Valenciana&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Participantes</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Se determin&#243; revisar un m&#237;nimo de 2&#46;397 historias cl&#237;nicas &#40;nivel de confianza del 95&#37; y una precisi&#243;n del 2&#37;&#41;&#46; La muestra se estratific&#243; por grupos de edad de forma proporcional a su frecuentaci&#243;n y con revisi&#243;n paritaria de historias de hombres y mujeres&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Mediciones principales</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">N&#250;mero y gravedad de los EAE identificados entre febrero de 2018 y septiembre de 2019&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Resultados</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Se revisaron un total de 2&#46;557 historias cl&#237;nicas &#40;1&#46;928&#44; 75&#46;4&#37; de pacientes adultos y 629&#44; 24&#46;6&#37; pedi&#225;tricos&#41;&#46; Se identificaron 182 EAE que afectaron a 168 pacientes &#40;7&#44;1&#37;&#44; IC 95&#37; 6&#44;1-8&#44;1&#37;&#41;&#59; en adultos 7&#44;6&#37; &#40;IC 95&#37; 6&#44;4-8&#44;8&#37;&#41; y 5&#44;7&#37; &#40;IC 95&#37; 3&#44;9-7&#44;5&#37;&#41; en pacientes pedi&#225;tricos&#46; Las mujeres sufrieron m&#225;s EAE que los hombres &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;004&#41;&#46; La incidencia de EAE en ni&#241;os y ni&#241;as fue similar &#40;p &#61; 0&#44;3&#41;&#46; 6 &#40;4&#46;1&#37;&#41; de los EAE supusieron un da&#241;o permanente en pacientes adultos&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Conclusiones</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Buscar f&#243;rmulas para incrementar la seguridad en AP&#44; particularmente en pacientes mujeres&#44; debe seguir siendo un objetivo prioritario incluso en pediatr&#237;a&#46; Uno de cada 24 EAE supone un da&#241;o grave y permanente en el adulto&#46;</p></span>"
        "secciones" => array:7 [
          0 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Objetivo"
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          1 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Dise&#241;o"
          ]
          2 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Emplazamiento"
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          3 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Participantes"
          ]
          4 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Mediciones principales"
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          5 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Resultados"
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          6 => array:2 [
            "identificador" => "abst0045"
            "titulo" => "Conclusiones"
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      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Objective</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">To determine the frequency of avoidable adverse events &#40;AAEs&#41; in Primary Care &#40;PC&#41;&#46;</p></span> <span id="abst0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Design</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Retrospective cohort study&#46;</p></span> <span id="abst0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Location</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Family medicine and paediatric clinics in Andalusia&#44; Aragon&#44; Castilla-La Mancha&#44; Catalonia&#44; Madrid&#44; Navarre&#44; and Valencia&#46;</p></span> <span id="abst0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Participants</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">A review was performed on a designated sample of 2&#44;397 medical records &#40;95&#37; confidence level and 2&#37; accuracy&#41;&#46; The sample was stratified by age group as regards the frequency of physician consultations and considering equal distribution of male and female patients&#46;</p></span> <span id="abst0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Main measurements</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Number and severity of identified AAEs from February 2018 to September 2019&#46;</p></span> <span id="abst0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Results</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">A total of 2&#44;557 medical records were reviewed &#40;1&#44;928&#44; 75&#46;4&#37; of adult patients&#44; and 629&#44; 24&#46;6&#37; paediatrics&#41;&#46; A total of 182 &#40;7&#46;1&#37;&#44; 95&#37; CI 6&#46;1-8&#46;1&#37;&#41; AAEs that affected 168 patients were identified&#44; which included 7&#46;6&#37; &#40;95&#37; CI 6&#46;4-8&#46;8&#37;&#41; in adults and 5&#46;7&#37; &#40;95&#37; CI 3&#46;9-7&#46;5&#37;&#41; in paediatric patients&#46; The number of AAEs in women was higher than in men &#40;<span class="elsevierStyleItalic">P</span> &#61; 0&#46;006&#41;&#46; The incidence of AAEs in boys and girls was similar &#40;<span class="elsevierStyleItalic">P</span> &#61; 0&#46;3&#41;&#46; Permanent damage was caused by AAEs in 6 &#40;4&#46;1&#37;&#41; adult patients&#46;</p></span> <span id="abst0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conclusions</span><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Seeking formulas to increase patient safety in PC should remain a priority objective&#44; particularly in female patients and in paediatrics&#46; One in 24 AAEs causes serious and permanent damage in adults&#46;</p></span>"
        "secciones" => array:7 [
          0 => array:2 [
            "identificador" => "abst0050"
            "titulo" => "Objective"
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          1 => array:2 [
            "identificador" => "abst0055"
            "titulo" => "Design"
          ]
          2 => array:2 [
            "identificador" => "abst0060"
            "titulo" => "Location"
          ]
          3 => array:2 [
            "identificador" => "abst0065"
            "titulo" => "Participants"
          ]
          4 => array:2 [
            "identificador" => "abst0070"
            "titulo" => "Main measurements"
          ]
          5 => array:2 [
            "identificador" => "abst0075"
            "titulo" => "Results"
          ]
          6 => array:2 [
            "identificador" => "abst0080"
            "titulo" => "Conclusions"
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        ]
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          0 => array:4 [
            "apendice" => "<p id="par0135" class="elsevierStylePara elsevierViewall">Ana Fern&#225;ndez&#44; Javier Gonz&#225;lez de Dios&#44; Cristina Nebot&#44; Juli&#225;n Vitaller&#44; Elena Caride Miana&#44; Alberto Asencio Aznar&#44; Vicente Rodr&#237;guez Sempere&#44; Mar&#237;a Isabel Hervella Durantez&#44; Antonio Molina Santiago&#44; Carmen Mar&#237;a Hermida Carbonell&#44; Mar&#237;a Juan Andr&#233;s&#44; Mar&#237;a del Mar Bastante Romero&#44; Blanca Puntes Felipe&#44; Diego Pueyo Gasc&#243;n&#44; Marta Dom&#237;nguez Garc&#237;a&#44; Daniel Ferrer Sorolla&#44; Imma Hospital Guardiola&#44; Eva Oya Girona&#44; Jos&#233; Manuel L&#243;pez Su&#225;rez&#44; Amalia Pinilla de Torre&#44; Irene Centeno Garc&#237;a&#44; B&#225;rbara Sanchez Pina&#44; Ana Romero Garc&#237;a&#44; Tania Mar&#237;a Cede&#241;o Benavides&#44; Irays Desire&#233; Corro Castro&#44; Esther Acosta Acosta&#44; Javier S&#225;nchez Holgado&#44; Alba Marina Alfaro Hern&#225;ndez&#44; Cristina Palacios Palomares&#46;</p>"
            "etiqueta" => "Anexo"
            "titulo" => "&#42;Grupo SOBRINA"
            "identificador" => "sec0070"
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          "leyenda" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">N &#40;&#37;&#41;&#46;</p><p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">MF&#58; Medicina de familia &#40;adultos&#41;&#44; PED&#58; Pediatr&#237;a&#46;</p>"
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">MF&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">PED&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">N&#250;mero de historias cl&#237;nicas revisadas&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1928 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">629 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Varones &#40;MF&#41;&#47;ni&#241;os &#40;PED&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">924 &#40;47&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">312 &#40;49&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mujeres &#40;MF&#41;&#47;ni&#241;as &#40;PED&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">1004 &#40;52&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">317 &#40;50&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Edad</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">23 &#40;3&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">267 &#40;13&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>65-74 a&#241;os &#40;MF&#41; &#47; 6-14 a&#241;os &#40;PED&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">944 &#40;49&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">258 &#40;41&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>75-80 a&#241;os &#40;MF&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">315 &#40;16&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#62; 80 a&#241;os &#40;MF&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">193 &#40;10&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Da&#241;o al paciente</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Pacientes que sufrieron un EA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">124 &#40;6&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32 &#40;5&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Pacientes que sufrieron dos EA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  """
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2&#44;4 &#8211; 7&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#250;mero de pacientes que sufrieron un EAE&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">5&#44;8 &#8211; 8&#44;1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">5&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;6 &#8211; 7&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hombres&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">4&#44;0 &#8211; 6&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">6&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">3&#44;7 &#8211; 9&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mujeres&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">85&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">6&#44;7 &#8211; 10&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">4&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2&#44;2 &#8211; 6&#44;7&nbsp;\t\t\t\t\t\t\n
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                  """
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                  \t\t\t\t">Total &#40;N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>629&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;6 &#8211; 7&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1-12 meses &#40;N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>23&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">2-5 a&#241;os &#40;N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>348&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">7&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">4&#44;9 &#8211; 10&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">6-14 a&#241;os &#40;N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>258&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;7 &#8211; 4&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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              ]
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        "descripcion" => array:1 [
          "es" => "<p id="spar0125" class="elsevierStyleSimplePara elsevierViewall">Frecuencia de eventos adversos evitables por rangos de edad</p>"
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          "leyenda" => "<p id="spar0140" class="elsevierStyleSimplePara elsevierViewall">Ninguno de los eventos adversos identificados produjo la muerte del paciente&#46;</p>"
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                  \t\t\t\t">Da&#241;o temporal leve&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Da&#241;o leve permanente&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">16&#44;3 &#40;15&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">8&#44;8 &#8211; 23&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Da&#241;o grave permanente&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;0 &#8211; 6&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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        "descripcion" => array:1 [
          "es" => "<p id="spar0135" class="elsevierStyleSimplePara elsevierViewall">Gravedad de los eventos adversos evitables identificados mediante revisi&#243;n de la historia cl&#237;nica apoyada mediante &#8220;triggers&#8221; &#8211; Medicina de familia adultos</p>"
        ]
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        "etiqueta" => "Tabla 5"
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        "mostrarFloat" => true
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        "detalles" => array:1 [
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          "leyenda" => "<p id="spar0150" class="elsevierStyleSimplePara elsevierViewall">n &#40;&#37;&#41;&#46;</p><p id="spar0155" class="elsevierStyleSimplePara elsevierViewall">MF&#58; M&#233;dico de Familia&#44; PED&#58; Pediatra&#46;</p><p id="spar0160" class="elsevierStyleSimplePara elsevierViewall">Medicaci&#243;n&#58; p&#46; e&#46;&#44; cefalea por f&#225;rmacos&#44; error en la v&#237;a de administraci&#243;n&#44; n&#225;useas&#44; v&#243;mitos&#44; mareos o diarrea secundarios a medicaci&#243;n&#44; reacci&#243;n al&#233;rgica&#44; etc&#46;&#59; Procedimientos y cuidados&#58; p&#46; e&#46;&#44; lesiones&#44; flebitis&#44; etc&#46;&#59; Asistencia sanitaria&#58; p&#46; e&#46;&#44; neumon&#237;a o infecci&#243;n relacionada con la asistencia&#44; etc&#46;</p>"
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Medicaci&#243;n&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">MF&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">50 &#40;92&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">73 &#40;95&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2 &#40;2&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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Información del artículo
ISSN: 02126567
Idioma original: Español
DOI:10.1016/j.aprim.2020.02.008
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Atención Primaria
Revista relacionada


Atención Primaria Práctica



Atención Primaria sigue las recomendaciones para la preparación, presentación y publicación de trabajos académicos en revistas biomédicas

es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

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

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos