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ORIGINAL
Factores predictivos de destino al alta tras una lesión medular
Predictive factors of destination at discharge after spinal cord injury
E. Bárbara-Batallera,
Autor para correspondencia
ebb31604@hotmail.com

Autor para correspondencia.
, J.L. Méndez-Suáreza, C. Alemán-Sáncheza, P. Peñaloza-Polob, J. Sánchez-Enríqueza, P. Saavedra-Santanac
a Unidad de Lesionados Medulares, Servicio de Rehabilitación del Hospital Universitario Insular de Gran Canaria, Las Palmas, España
b Servicio de Rehabilitación del Hospital Universitario Insular de Gran Canaria, Las Palmas, España
c Área de Estadística e Investigación Operativa del Departamento de Matemáticas de la Universidad de Las Palmas de Gran Canaria, Las Palmas, España
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econ&#243;micas y de salud p&#250;blica entre pa&#237;ses<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">2</span></a>&#46; Seg&#250;n los &#250;ltimos estudios regionales en Espa&#241;a&#44; la incidencia oscila entre los 9&#44;8 y los 21&#44;7 c&#47;m&#47;a<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">3&#8211;5</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">El objetivo principal de la rehabilitaci&#243;n en el lesionado medular es proporcionar todas las herramientas al paciente para que consiga la m&#225;xima independencia en funci&#243;n de su lesi&#243;n neurol&#243;gica&#44; edad y comorbilidad<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">6</span></a>&#46; El otro gran objetivo es la reintegraci&#243;n del paciente al entorno familiar&#44; social y laboral<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">7</span></a>&#46; Por tanto&#44; que el paciente que ha sufrido una lesi&#243;n medular y ha completado un periodo de rehabilitaci&#243;n intensiva en un centro especializado sea derivado al alta hospitalaria a una residencia sociosanitaria o a un centro de pacientes cr&#243;nicos no puede ser considerado un buen resultado<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">8</span></a>&#46; Si bien es cierto que estos centros proporcionan la asistencia y los cuidados m&#233;dicos que el paciente puede precisar&#44; tambi&#233;n implica una restricci&#243;n de la independencia del individuo y de la interacci&#243;n con su entorno m&#225;s cercano&#44; lo cual es percibido como una p&#233;rdida de calidad de vida&#46; Este destino al alta es la &#250;nica alternativa cuando el paciente no dispone de un entorno que pueda cubrir las necesidades asistenciales que necesita<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">9</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Existen en la literatura diferentes estudios en los que se ha valorado con mayor o menor profundidad el destino al alta de los pacientes que han ingresado en unidades especializadas por una lesi&#243;n medular aguda<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">6&#44;7&#44;10&#8211;12</span></a>&#46; Todos estos trabajos que se remontan hasta principios del a&#241;o 2000 y que ten&#237;an como referencia a una poblaci&#243;n predominantemente joven que hab&#237;a sufrido una lesi&#243;n medular como consecuencia&#44; en la mayor&#237;a de los casos&#44; de un accidente de tr&#225;fico&#46; Desde entonces hasta ahora el perfil del lesionado medular ha cambiado de forma sustancial&#46; La media de edad del paciente est&#225; aumentando y est&#225; asociada principalmente a un predominio de las ca&#237;das en gente mayor como principal causa de lesi&#243;n medular<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">3</span></a>&#46; Este tipo de pacientes de mayor edad condiciona un cambio en la planificaci&#243;n de su proceso rehabilitador con unos objetivos funcionales menos ambiciosos&#44; lo que condiciona una mayor discapacidad<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">13</span></a>&#46; Esto a su vez ha provocado un aumento de la derivaci&#243;n de estos pacientes a una residencia o centro sociosanitario<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">3</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">El objetivo de este trabajo es determinar qu&#233; factores condicionan que un paciente que ha sufrido una lesi&#243;n medular y ha completado un programa de rehabilitaci&#243;n en un centro especializado&#44; sea derivado a una residencia sociosanitaria&#47;centro de cr&#243;nicos vs&#46; un domicilio particular &#40;propio&#44; familiar o de amigos&#41;&#46; Conocer estos factores desde el inicio del proceso rehabilitador permitir&#237;a anticipar al equipo multidisciplinar con el paciente y su entorno&#44; las posibilidades de destino en el momento del alta hospitalaria&#46; Asimismo&#44; estos datos pueden ser de inter&#233;s para los servicios sociales y sanitarios que intervienen en la derivaci&#243;n de estos pacientes a estos centros cuando es necesario&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material y m&#233;todos</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Poblaci&#243;n de estudio</span><p id="par0025" class="elsevierStylePara elsevierViewall">Se ha realizado un estudio retrospectivo descriptivo de todos los pacientes que han sufrido una lesi&#243;n medular de origen traum&#225;tico y que han completado un programa de rehabilitaci&#243;n intensivo en una unidad especializada para este tipo de lesi&#243;n&#46; La Unidad de Lesionados Medulares &#40;ULM&#41; de Canarias se encuentra en el Complejo Hospitalario Universitario Insular Materno-Infantil &#40;CHUIMI&#41; de Gran Canaria&#44; Espa&#241;a&#44; y es centro de referencia regional para todo la Comunidad Canaria&#46; Esta regi&#243;n est&#225; compuesta por ocho islas&#44; siendo Gran Canaria y Tenerife&#44; las dos capitales&#44; las islas m&#225;s pobladas &#40;859&#46;835 y 933&#46;402 habitantes&#44; respectivamente&#41;&#46; Seg&#250;n el Instituto Canario de Estad&#237;stica&#44; la poblaci&#243;n de la Comunidad Canaria en el 2018 era de 2&#46;177&#46;000<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">14</span></a>&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Criterios de inclusi&#243;n y exclusi&#243;n</span><p id="par0030" class="elsevierStylePara elsevierViewall">Se han incluido todos los pacientes que han ingresado en la Unidad de Lesionados Medulares por una lesi&#243;n medular aguda de origen traum&#225;tico &#40;c&#243;digos 806 y 952 del ICD-9&#41; desde el 1 de enero del 2001 hasta el 31 de diciembre de 2018&#46; Se han excluido aquellos pacientes fallecidos durante el ingreso en la unidad&#44; pacientes transferidos a otras unidades&#47;centros hospitalarios antes de finalizar el programa de rehabilitaci&#243;n y pacientes menores de 15 a&#241;os&#46; De los 335 pacientes que ingresaron durante el periodo del estudio&#44; nueve pacientes fallecieron durante el ingreso y 21 fueron trasladados a su regi&#243;n o pa&#237;s de origen&#44; por lo que la muestra del estudio fue de 305 pacientes&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Fuente de informaci&#243;n</span><p id="par0035" class="elsevierStylePara elsevierViewall">La informaci&#243;n ha sido obtenida de la base de datos hospitalaria y de la documentaci&#243;n cl&#237;nica de los pacientes durante el periodo de ingreso&#46; El autor principal del estudio ha recogido los datos anualmente a partir de los registros hospitalarios&#44; ha contrastado los pacientes incluidos en el estudio con el Servicio de Admisi&#243;n y Traslados&#44; y ha sido el responsable de la codificaci&#243;n de los datos durante todo el periodo del estudio&#46; A pesar de ello&#44; y debido a la ausencia de un registro regional de los pacientes hospitalizados&#44; no se ha podido contrastar el destino definitivo de los pacientes de la isla de Tenerife&#46; Estos pacientes&#44; a trav&#233;s de los servicios sociales hospitalarios de su isla&#44; ser&#237;an posteriormente trasladados a una residencia sociosanitaria&#46; El estudio fue aprobado por el Comit&#233; de &#201;tica del CHUIMI &#40;CEIm-CHUIMI-2017&#47;969&#46;&#41;&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Variables</span><p id="par0040" class="elsevierStylePara elsevierViewall">Las variables recogidas se han organizado en diferentes categor&#237;as&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">-</span><p id="par0045" class="elsevierStylePara elsevierViewall">Variables sociodemogr&#225;ficas&#58; edad&#44; sexo&#44; estado civil&#44; n&#250;mero de hijos&#44; isla de residencia&#44; domicilio habitual&#44; nivel estudios y situaci&#243;n laboral&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">-</span><p id="par0050" class="elsevierStylePara elsevierViewall">Variables relacionadas con los antecedentes t&#243;xicos o m&#233;dicos&#58; tabaco&#44; alcohol&#44; drogas&#44; diabetes mellitus&#44; hipertensi&#243;n arterial &#40;HTA&#41;&#44; cardiopat&#237;a isqu&#233;mica y antecedentes psiqui&#225;tricos&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">-</span><p id="par0055" class="elsevierStylePara elsevierViewall">Variables relacionadas con la lesi&#243;n medular&#58; a&#241;o de la lesi&#243;n&#44; etiolog&#237;a&#44; accidente laboral&#44; fractura vertebral&#44; intervenci&#243;n de la fractura&#44; lesi&#243;n neurol&#243;gica &#40;tetraplejia completa&#44; tetraplejia incompleta&#44; paraplejia completa&#44; paraplejia incompleta&#41;&#44; tipo de lesi&#243;n medular&#44; severidad de la lesi&#243;n&#44; seg&#250;n la clasificaci&#243;n <span class="elsevierStyleItalic">American Spinal Injury Association</span> &#40;ASIA&#41; <span class="elsevierStyleBold">&#40;</span><a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a><span class="elsevierStyleBold">&#41;</span><a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">15</span></a> y manejo vesical de la vejiga neur&#243;gena al alta&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">-</span><p id="par0060" class="elsevierStylePara elsevierViewall">Variables hospitalarias&#58; tiempo desde la lesi&#243;n hasta el ingreso en la ULM&#44; tiempo de estancia hospitalaria en la ULM y destino al alta&#46;</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">-</span><p id="par0065" class="elsevierStylePara elsevierViewall">Variable funcional&#58; se ha medido la funci&#243;n con la <span class="elsevierStyleItalic">Spinal Cord Independence Measure Scale</span> &#40;SCIM&#44; versi&#243;n III&#41;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">16</span></a>&#44; determin&#225;ndose la SCIM por apartados y SCIM total&#46; Las puntuaciones de cada subgrupo y total se agruparon por su puntuaci&#243;n &#40;cada 5 puntos en subgrupo 1 de autocuidados&#59; cada 10 puntos en subgrupo 2 de respiraci&#243;n y esf&#237;nteres&#44; y subgrupo 3 de movilidad&#59; y cada 20 puntos en SCIM total&#41;&#46;</p></li></ul></p><p id="par0070" class="elsevierStylePara elsevierViewall">Para mejorar la precisi&#243;n del estudio en el an&#225;lisis multivariante&#44; los valores de diferentes variables se agruparon de forma binaria&#46; As&#237;&#44; en estado civil los valores se agruparon en pareja&#47;casado vs&#46; las dem&#225;s&#59; la vivienda en propia &#40;solo&#44; conyugal o paterna&#41; vs&#46; al resto&#59; la situaci&#243;n laboral entre activos laboralmente vs&#46; al resto&#59; los fumadores &#40;diario y ocasional&#41; vs&#46; al resto&#59; el consumo de alcohol &#40;t&#243;xico y diario&#41; vs&#46; al resto&#59; drogas &#40;duras y&#47;o blandas&#41; vs&#46; no drogas&#59; presencia de antecedente psiqui&#225;trico vs&#46; ausencia y residencia en la isla de Tenerife vs&#46; al resto&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Estudio estad&#237;stico</span><p id="par0075" class="elsevierStylePara elsevierViewall">Las variables categ&#243;ricas se han resumido en frecuencias y porcentajes&#44; y las cuantitativas en medias y desviaciones t&#237;picas &#40;SD&#41; cuando los datos segu&#237;an una distribuci&#243;n normal&#44; o en medianas y rangos intercuart&#237;licos &#40;IQR &#61; percentiles 25-75&#41;&#44; en caso contrario&#46; Los porcentajes se compararon usando&#44; seg&#250;n procediera&#44; el test &#967;<span class="elsevierStyleSup">2</span> o el exacto de Fisher&#59; las medias mediante el <span class="elsevierStyleItalic">t</span> test&#59; y las medianas mediante el test de Wilcoxon para datos independientes&#46; Para determinar qu&#233; factores ten&#237;an una asociaci&#243;n independiente con el destino se ha realizado una regresi&#243;n log&#237;stica multivariante&#46; Las variables que mostraron una asociaci&#243;n significativa con el destino fueron incluidas en el an&#225;lisis multivariante&#46; Entonces se realiz&#243; una selecci&#243;n de las variables basada en los m&#233;todos <span class="elsevierStyleItalic">best subset regression</span> y criterio de informaci&#243;n de Akaike &#40;AIC&#41;&#46; El modelo obtenido se resumi&#243; en coeficientes&#44; errores est&#225;ndar &#40;SE&#41;&#44; valores p y OR&#44; las cuales se estimaron mediante intervalos de confianza al 95&#37; &#40;IC 95&#37;&#41;&#46; Del modelo log&#237;stico se dedujo un <span class="elsevierStyleItalic">SCORE</span> de predicci&#243;n&#44; el cual de defini&#243; como la combinaci&#243;n lineal de las variables que da el modelo log&#237;stico&#46; Este <span class="elsevierStyleItalic">SCORE</span> proporciona una regla predictiva para el destino del paciente de la siguiente forma&#58; un paciente es susceptible de ser derivado a una residencia&#44; si y solo si&#44; su SCORE supera un cierto umbral C &#40;<span class="elsevierStyleItalic">cut off</span>&#41;&#46; Cada <span class="elsevierStyleItalic">cut off</span> C tiene asociada una sensibilidad y una especificidad&#46; La curva <span class="elsevierStyleItalic">receiver operating characteristics</span> &#40;ROC&#41; consiste en la representaci&#243;n gr&#225;fica de las sensibilidades frente a sus correspondientes coeficientes falsos positivos &#40;1 - <span class="elsevierStyleItalic">especificidad</span>&#41;&#46; La capacidad discriminante de la regla predictiva se evalu&#243; mediante el &#225;rea bajo la correspondiente curva ROC&#46; Se consider&#243; como <span class="elsevierStyleItalic">cut off</span> &#243;ptimo aquel que minimiza la cantidad &#40;punto de la curva m&#225;s pr&#243;xima a la esquina superior izquierda<span class="elsevierStyleItalic">&#41;</span>&#58;<elsevierMultimedia ident="eq0005"></elsevierMultimedia></p><p id="par0080" class="elsevierStylePara elsevierViewall">Para este valor de corte &#243;ptimo&#44; se estimaron la <span class="elsevierStyleItalic">sensibilidad</span> y <span class="elsevierStyleItalic">especificidad</span> mediante IC 95&#37;&#46; El nivel de significaci&#243;n se ha establecido para p &#60; 0&#44;05&#46; Los datos se han analizado con el R package&#44; version 3&#46;5&#46;1 &#40;R Development Core Team&#44; 2018&#41;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">17</span></a>&#46;</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Resultados</span><p id="par0085" class="elsevierStylePara elsevierViewall">Las caracter&#237;sticas de la poblaci&#243;n estudiada y el destino al alta hospitalaria est&#225;n descritas en la <a class="elsevierStyleCrossRef" href="#tbl0020">tabla 2</a>&#44; a partir de un an&#225;lisis univariante&#46; Las variables que se relacionaron de forma significativa con el destino al alta a un centro sociosanitario fueron&#58; la edad&#44; isla de residencia&#44; estado civil&#44; vivienda previa&#44; situaci&#243;n laboral en el momento de la lesi&#243;n&#44; antecedente de fumador&#44; alcohol&#44; DM tipo 2&#44; HTA&#44; dislipemia&#44; antecedente psiqui&#225;trico&#44; la etiolog&#237;a de la lesi&#243;n&#44; el tiempo desde la lesi&#243;n hasta la llegada a la ULM&#44; la lesi&#243;n neurol&#243;gica&#44; la clasificaci&#243;n ASIA&#44; el manejo vesical al alta hospitalaria y la funci&#243;n del individuo valorada por la SCIM en los tres subgrupos de funci&#243;n y en el total&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">Durante el periodo de estudio se ha observado un aumento de la derivaci&#243;n de estos pacientes a un centro sociosanitario&#46; Entre el 2001-2010 fueron derivados el 9&#44;14&#37; de los pacientes&#44; mientras que entre el 2011-2018 lo fueron el 18&#44;4&#37; &#40;p &#60; 0&#44;01&#41;&#46; Una de las asociaciones significativas m&#225;s fuertes fue la edad avanzada&#46; De los pacientes menores de 30 a&#241;os&#44; ninguno fue derivado a un centro sociosanitario&#59; de los pacientes entre 31-45 a&#241;os fueron derivados el 10&#37;&#59; mientras que de los mayores de 75 a&#241;os fueron derivados a un centro sociosanitario el 42&#44;5&#37; &#40;p &#60; 0&#44;01&#41;&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Los resultados del an&#225;lisis por regresi&#243;n log&#237;stica multivariante se muestran en la <a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#46; De las 20 variables significativas en el an&#225;lisis univariante&#44; siete fueron significativas en el estudio multivariante&#58; la edad &#40;a&#241;os&#41;&#44; ser residente en la isla de Tenerife&#44; estar casado&#44; ser fumador&#44; tener DM tipo 2&#44; tener un antecedente psiqui&#225;trico y la puntuaci&#243;n en la SCIM total&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">De la regresi&#243;n log&#237;stica se deduce el siguiente <span class="elsevierStyleItalic">SCORE</span> &#40;combinaci&#243;n lineal de las variables del modelo&#41;&#58;<elsevierMultimedia ident="eq0010"></elsevierMultimedia></p><p id="par0105" class="elsevierStylePara elsevierViewall">La <a class="elsevierStyleCrossRef" href="#fig0005">figura 1</a> muestra la curva ROC correspondiente al SCORE de predicci&#243;n para el destino&#46; El &#225;rea bajo la curva estimada fue de 0&#44;901 &#40;IC 95&#37; &#61; 0&#44;84&#59; 0&#44;962&#41;&#46; El valor de corte &#243;ptimo fue de 1&#46;028&#46; Esto significa que un paciente con un <span class="elsevierStyleItalic">SCORE</span> superior a este valor es susceptible de ser derivado a una residencia&#46; Para este predictor&#44; la sensibilidad estimada es de 0&#44;868 &#40;IC 95&#37; &#61; 0&#44;763&#59; 0&#44;947&#41; y la especificidad de 0&#44;813 &#40;IC 95&#37; &#61; 0&#44;735&#59; 0&#44;948&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall">En la <a class="elsevierStyleCrossRef" href="#fig0010">figura 2</a> queda reflejado el poder discriminante de la puntuaci&#243;n&#46; Ejemplo&#58; paciente de 41 a&#241;os&#44; no diab&#233;tico &#40;<span class="elsevierStyleItalic">DM2</span> &#61; 0&#41;&#44; casado &#40;<span class="elsevierStyleItalic">Pareja</span> &#61; 1&#41;&#44; no fumador &#40;<span class="elsevierStyleItalic">fumador</span> &#61; 0&#41;&#44; sin antecedente psiqui&#225;trico &#40;<span class="elsevierStyleItalic">a&#46; psiqui&#225;trico</span> &#61; 0&#41;&#44; de Gran Canaria &#40;<span class="elsevierStyleItalic">Tenerife</span> &#61; 0&#41; y <span class="elsevierStyleItalic">SCIM</span><span class="elsevierStyleInf"><span class="elsevierStyleItalic">total</span></span> &#61; nivel 5&#46; En este caso&#44; su puntuaci&#243;n es&#58;<elsevierMultimedia ident="eq0015"></elsevierMultimedia></p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Discusi&#243;n</span><p id="par0115" class="elsevierStylePara elsevierViewall">Actualmente existe un consenso generalizado de que los pacientes que sufren una lesi&#243;n medular aguda deben ser trasladados a una Unidad de Lesionados Medulares &#40;ULM&#41;&#44; tan pronto como sea posible&#46; Diversos estudios han observado que el traslado precoz a centros especializados mejora la funci&#243;n y la independencia y disminuye la estancia hospitalaria&#44; las complicaciones derivadas de la lesi&#243;n y su gravedad y la mortalidad del lesionado medular respecto a otros hospitales traumatol&#243;gicos no especializados en su manejo<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">18&#8211;20</span></a>&#46; Asimismo&#44; estas unidades cumplen de forma m&#225;s eficaz con otro de los objetivos con estos pacientes en el momento del alta hospitalaria&#44; un mayor porcentaje de retorno al domicilio privado y&#44; por tanto&#44; a su reintegraci&#243;n en la comunidad<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">21</span></a>&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">A pesar de que el destino al alta hospitalaria tras una lesi&#243;n medular traum&#225;tica ha sido estudiado ampliamente en EE&#46; UU&#46;<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">9&#44;22</span></a>&#44; Australia<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">11</span></a>&#44; Canad&#225;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">7</span></a> o Reino Unido<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">10</span></a>&#44; no existe informaci&#243;n reciente al respecto en nuestro medio&#46; En nuestro estudio&#44; el 86&#44;8&#37; de los pacientes ha retornado a su entorno sociofamiliar&#46; Es un dato similar al australiano &#40;86&#44;2&#37;&#41;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">11</span></a> y a otros estudios similares con un porcentaje que oscila entre el 80 y 95&#37;<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">8&#44;22</span></a>&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">En este estudio se han identificado los factores que han influido para que un paciente que ha sufrido una lesi&#243;n medular traum&#225;tica aguda y ha completado su periodo de rehabilitaci&#243;n en la ULM de Canarias&#44; sea derivado a un centro sociosanitario vs&#46; un domicilio privado &#40;propio&#44; conyugal&#44; familiar o amigos&#41;&#46; Estudios recientes hab&#237;an observado un incremento del paciente que es derivado a centros de cr&#243;nicos<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">22&#44;23</span></a>&#46; En Canarias entre el 2001-2005&#44; el porcentaje de pacientes que fueron derivados a un centro de cr&#243;nicos fue del 8&#44;5&#37;&#44; un porcentaje que aument&#243; de forma significativa al 20&#37; entre el 2011-2015 y que contin&#250;a con esta misma tendencia en este estudio del mismo autor<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">3</span></a>&#46; Este aumento se podr&#237;a deber al cambio en el perfil de la poblaci&#243;n diana&#44; con un predominio de la poblaci&#243;n de edad m&#225;s avanzada que sufre una lesi&#243;n medular&#44; en la mayor&#237;a de los casos cervical incompleta y como consecuencia de una ca&#237;da<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">3&#44;5</span></a>&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">En este trabajo se han observado diferentes variables que se han relacionado de forma significativa con el destino a un centro sociosanitario como son factores sociodemogr&#225;ficos &#40;edad&#44; estado civil&#44; residencia habitual o actividad laboral&#41;&#44; antecedentes t&#243;xicos o patol&#243;gicos &#40;tabaco&#44; alcohol&#44; DM2&#44; HTA&#44; dislipemia&#44; cardiopat&#237;a isqu&#233;mica&#44; accidente cerebrovascular&#44; antecedente psiqui&#225;trico&#41;&#44; factores relacionados con la lesi&#243;n &#40;etiolog&#237;a&#44; ASIA&#44; lesi&#243;n neurol&#243;gica y tiempo de ingreso&#41; y factores relacionados con la funci&#243;n al alta hospitalaria &#40;manejo vesical&#44; subgrupos de SCIM y SCIM total&#41;&#46; De entre estas variables&#44; las que mantienen asociaci&#243;n independiente con el destino al alta son aquellas que resultaron seleccionadas en el an&#225;lisis log&#237;stico multivariante&#44; el cual se resume en la <a class="elsevierStyleCrossRef" href="#tbl0020">tabla 2</a>&#46; Se observa c&#243;mo la edad es un factor predictor que incrementa en 0&#44;054&#47;a&#241;o el riesgo del paciente con lesi&#243;n medular a ser derivado a un centro de cr&#243;nicos&#46; Este dato coincide con otras series de estudios de los a&#241;os 90 y principios del 2000<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">7&#44;22&#44;24</span></a>&#46; Hsieh observ&#243; que por debajo de los 30 a&#241;os solo fueron derivados el 2&#37; de los pacientes&#44; mientras que en los mayores de 60 a&#241;os el porcentaje aumentaba al 17&#44;2&#37;&#46; Este dato estaba relacionado en su estudio con una menor puntuaci&#243;n en la <span class="elsevierStyleItalic">Functional Independence Measure</span> &#40;FIM&#41; al ingreso y al alta y que estaba condicionada por una lesi&#243;n neurol&#243;gica que suele ser m&#225;s severa &#40;tetraplejia incompleta&#41; y por una menor capacidad para el aprovechamiento del programa de rehabilitaci&#243;n&#44; respectivamente<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">25&#44;26</span></a>&#46; DeVivo presentaba datos similares a este estudio&#44; siendo derivados el 1&#44;4&#37; de los pacientes entre 16-30 a&#241;os y el 22&#44;2&#37; de los mayores de 75 a&#241;os &#40;en el estudio actual 2&#44;6 y 18&#44;4&#37;&#44; respectivamente&#41;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">6</span></a>&#46; Resulta evidente que al aumentar la edad media de los pacientes que sufren una lesi&#243;n medular y su esperanza de vida&#44; se debe poner especial atenci&#243;n en proporcionar los recursos espec&#237;ficos para esta poblaci&#243;n que&#44; si sigue esta tendencia&#44; seguir&#225; aumentando&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Los antecedentes patol&#243;gicos previos a la lesi&#243;n se han relacionado con el destino al alta a una residencia&#44; un dato ampliamente observado en el an&#225;lisis univariante y que se confirm&#243; de forma significativa en la regresi&#243;n multivariante espec&#237;ficamente con el consumo de tabaco&#44; la DM tipo 2 y la presencia de antecedentes psiqui&#225;tricos&#46; Aunque la edad podr&#237;a estar relacionada con estos h&#225;bitos t&#243;xicos y antecedentes&#44; tambi&#233;n existe en la actualidad una mayor concienciaci&#243;n de la salud que est&#225; m&#225;s arraigada en diferentes sectores de la sociedad&#44; relacionada con la actividad laboral y los niveles educacionales<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">27</span></a>&#46; En este estudio fueron derivados el 5&#44;6&#37; de los activos laboralmente vs&#46; el 21&#44;5&#37; de los que no trabajaban &#40;p &#60; 0&#44;01&#41;&#46; En cambio&#44; respecto al nivel educacional&#44; aunque fueron derivados a un centro sociosanitario el 15&#44;2&#37; de pacientes sin estudios o estudios primarios y este porcentaje disminuy&#243; al 9&#44;2&#37; entre los que ten&#237;an estudios secundarios o universitarios&#44; la diferencia no fue significativa&#46; La asociaci&#243;n de los antecedentes t&#243;xicos y m&#233;dicos con el destino al alta es un dato interesante y no valorado en estudios similares&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Un dato propio de este estudio&#44; y que es similar a otros estudios con Unidades que aglutinan diferentes islas o abarcan grandes territorios<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">11</span></a>&#44; es el porcentaje de pacientes derivados a un hospital m&#225;s cercano a su domicilio antes de ser derivados a un centro sociosanitario y que en nuestro estudio resid&#237;an en la isla de Tenerife&#46; Esto se debe a que estos pacientes pod&#237;an finalizar el tratamiento rehabilitador en un centro de su isla&#44; cerca de su entorno sociofamiliar y desde este centro &#40;con capacidad para gestionar recursos sociosanitarios propios&#41;&#44; se proceder&#237;a a la posterior derivaci&#243;n a un centro de cr&#243;nicos&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">La vida en pareja fue un factor protector de la derivaci&#243;n a una residencia &#40;OR &#61; 0&#44;264&#59; IC 95&#37; &#61; 0&#44;091-0&#44;760&#41;&#46; A pesar de la cobertura sanitaria universal y gratuita del Sistema Sanitario Espa&#241;ol&#44; los recursos sociales son limitados y las ayudas a domicilio a personas con gran discapacidad que viven solas no cubren toda la asistencia que estos pacientes pueden llegar a precisar&#46; Cuando el entorno m&#225;s cercano no puede proporcionar el cuidado adicional que precisan estos pacientes&#44; derivarlos a residencias sociosanitarias o centros de cr&#243;nicos constituyen la &#250;nica opci&#243;n&#46; Vivir con pareja es probable que sea una medida sustituta del apoyo social disponible en el hogar y el entorno general del lesionado medular&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Finalmente&#44; se ha observado como cabr&#237;a esperar&#44; que una mayor puntuaci&#243;n en SCIM total es un factor protector para que el paciente retorne a un domicilio particular&#46; Esto refleja&#44; como en otros estudios&#44; que una puntuaci&#243;n baja en la SCIM requiere proporcionalmente de una mayor asistencia diaria que aquellos con puntuaciones m&#225;s altas&#46; Este resultado tambi&#233;n estar&#237;a relacionado con el grado de severidad de la lesi&#243;n medular&#58; a mayor gravedad de la lesi&#243;n &#40;valorado como ASIA o lesi&#243;n neurol&#243;gica&#41;&#44; mayor necesidad de asistencia y&#44; por tanto&#44; mayor riesgo a ser derivado a un centro sociosanitario<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">11</span></a>&#46;</p><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Limitaciones del estudio</span><p id="par0155" class="elsevierStylePara elsevierViewall">Existen en este estudio una serie de limitaciones que impiden una generalizaci&#243;n de los resultados y las conclusiones&#46; Cada pa&#237;s&#44; e incluso cada regi&#243;n en un mismo pa&#237;s&#44; tiene las propias particularidades que no dependen solo de los sistemas sociosanitarios&#44; sino tambi&#233;n de las particularidades poblacionales y geogr&#225;ficas&#46; Esta unidad&#44; que cubre las necesidades de un archipi&#233;lago de ocho islas cuya &#250;nica v&#237;a de comunicaci&#243;n r&#225;pida y eficaz es por aire&#44; puede haber condicionado diferentes periodos de tiempo de rehabilitaci&#243;n&#44; en funci&#243;n del origen del paciente&#46; Por esta raz&#243;n&#44; los pacientes procedentes de la isla de Tenerife &#40;la otra capital de la regi&#243;n&#41; que dispone de recursos sociales propios&#44; pueden estar sobreestimados al ser trasladados al alta inicialmente a un hospital de su isla de forma transitoria&#44; previo a su destino final que no siempre puede haber sido ha sido un centro sociosanitario&#46; Pese a no disponer de todos los datos&#44; los autores de este trabajo consideran que el n&#250;mero de pacientes derivados finalmente a un domicilio privado han sido escasos&#46; Para confirmar esta creencia y corregir este peque&#241;o sesgo se deber&#237;a determinar el lugar de residencia final de paciente&#44; pasados unos meses del alta hospitalaria&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Otra limitaci&#243;n puede ser que&#44; a pesar de contar con los mismos recursos sanitarios&#44; rehabilitadores y sociales para todos los pacientes&#44; en este estudio no se han recogido otras variables que podr&#237;an haber influenciado de forma significativa en el an&#225;lisis realizado&#46; Estas variables incluyen las posibles indemnizaciones recibidas tras un posible accidente de tr&#225;fico o laboral&#44; el poder adquisitivo del paciente o las caracter&#237;sticas del entorno del domicilio del paciente&#58; rural vs&#46; urbano o accesible vs&#46; con barreras arquitect&#243;nicas&#46;</p></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Conclusiones</span><p id="par0165" class="elsevierStylePara elsevierViewall">En este estudio se ha observado que la edad avanzada&#44; ser residente en la isla de Tenerife&#44; no estar casado&#44; ser fumador&#44; tener DM tipo2&#44; tener un antecedente psiqui&#225;trico y la puntuaci&#243;n baja en SCIM total predicen con una alta sensibilidad y especificidad que un paciente que ha sufrido una lesi&#243;n medular traum&#225;tica y ha completado un programa de rehabilitaci&#243;n&#44; sea derivado a una residencia sociosanitaria y no a un domicilio particular&#46; El paciente con lesi&#243;n medular cada vez tiene m&#225;s edad&#44; m&#225;s comorbilidades y un entorno sociofamiliar m&#225;s limitado&#46; Con esta perspectiva&#44; es l&#243;gico pensar que la derivaci&#243;n de estos pacientes a residencias sociosanitarias o centros cr&#243;nicos seguir&#225; creciendo en los pr&#243;ximos a&#241;os&#46; El conocimiento de los factores que predisponen para que un paciente con lesi&#243;n medular aguda tras un periodo de rehabilitaci&#243;n especializada retorne a la comunidad o a un centro de cr&#243;nicos es &#250;til a diferentes niveles&#46; Para todo el equipo multidisciplinar que trabaja directamente en el programa de rehabilitaci&#243;n&#44; esta informaci&#243;n ayuda&#44; por un lado&#44; a planificar de forma m&#225;s realista los objetivos a conseguir durante el ingreso&#44; y por otro&#44; a planificar conjuntamente con el paciente y su entorno m&#225;s cercano el destino al alta y las reformas o ayudas que va precisar&#46; Para los sistemas sociosanitarios esta informaci&#243;n es &#250;til para planificar y poder destinar de forma m&#225;s eficiente los recursos necesarios para cubrir las necesidades de esta poblaci&#243;n&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">&#201;tica de la publicaci&#243;n cient&#237;fica</span><p id="par0170" class="elsevierStylePara elsevierViewall">El Comit&#233; de &#201;tica de Investigaci&#243;n del CHUIMI aprob&#243; este estudio retrospectivo &#40;CEIm-CHUIMI-2017&#47;969&#41;&#46; Se han tenido en cuenta las responsabilidades &#233;ticas de acuerdo con la Asociaci&#243;n M&#233;dica Mundial y la Declaraci&#243;n de Helsinki&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Financiaci&#243;n</span><p id="par0175" class="elsevierStylePara elsevierViewall">Este trabajo no ha recibido ning&#250;n tipo de financiaci&#243;n&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Conflicto de intereses</span><p id="par0180" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Contribuci&#243;n de los autores</span><p id="par0185" class="elsevierStylePara elsevierViewall">Todos los autores participaron de forma sustancial en&#58;<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">-</span><p id="par0190" class="elsevierStylePara elsevierViewall">la concepci&#243;n y el dise&#241;o del estudio&#44; o la adquisici&#243;n de datos&#44; o el an&#225;lisis y la interpretaci&#243;n de los datos</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">-</span><p id="par0195" class="elsevierStylePara elsevierViewall">el borrador del art&#237;culo o la revisi&#243;n cr&#237;tica del contenido intelectual</p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">-</span><p id="par0200" class="elsevierStylePara elsevierViewall">la aprobaci&#243;n definitiva de la versi&#243;n que se presenta&#46;</p></li></ul></p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introducci&#243;n</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Uno de los principales objetivos de la rehabilitaci&#243;n en el lesionado medular es la reintegraci&#243;n del individuo a su entorno familiar&#44; social y laboral&#46; El objetivo de este trabajo ha sido identificar los factores que determinan el destino al alta tras una lesi&#243;n medular aguda traum&#225;tica&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material y m&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Se ha realizado un estudio descriptivo retrospectivo de los 305 pacientes que han sufrido una lesi&#243;n medular y han completado el periodo de rehabilitaci&#243;n en la Unidad de Lesionados Medulares del Hospital Insular de Gran Canaria&#44; entre 2001-2018&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">En el periodo del estudio ha habido un incremento de los pacientes derivados a un centro sociosanitario&#44; pasando del 9&#44;14&#37; entre 2001-2010 al 18&#44;4&#37; entre 2011-2018 &#40;p &#60; 0&#44;01&#41;&#46; De las 20 variables en relaci&#243;n significativa con el destino al alta en el estudio univariante&#44; siete variables la tuvieron en el estudio multivariante&#58; edad &#40;<span class="elsevierStyleItalic">odds ratio</span> &#91;OR&#93; 1&#44;05&#44; intervalo de confianza &#91;IC&#93; 95&#37;&#44; 1&#44;02-1&#44;08&#41;&#44; vivir en pareja &#40;OR 0&#44;26&#44; IC 95&#37;&#44; 0&#44;09-0&#44;76&#41;&#44; residir en otra isla &#40;OR 3&#44;57&#44; IC 95&#37;&#44; 1&#44;32-9&#44;63&#41;&#44; ser fumador &#40;OR 3&#44;44&#44; IC 95&#37;&#44; 1&#44;26-9&#44;44&#41;&#44; diab&#233;tico &#40;OR 6&#44;51&#44; IC 95&#37;&#44; 1&#44;46-29&#44;02&#41;&#44; tener un antecedente psiqui&#225;trico &#40;OR 3&#44;79&#44; IC 95&#37;&#44; 1&#44;31-10&#44;93&#41; y la valoraci&#243;n funcional de la <span class="elsevierStyleItalic">Spinal Cord Independence Measure</span> &#40;SCIM III&#41; &#40;OR 0&#44;48&#44; IC 95&#37;&#44; 0&#44;33-0&#44;69&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">En este estudio se ha observado que la edad avanzada&#44; ser residente en la isla de Tenerife&#44; no estar casado&#44; ser fumador&#44; tener diabetes mellitus tipo 2 &#40;DM2&#41;&#44; tener un antecedente psiqui&#225;trico y la puntuaci&#243;n baja en el SCIM total son factores predictores para que un paciente que ha sufrido una lesi&#243;n medular traum&#225;tica en Canarias sea derivado a una residencia&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introduction</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">One of the main goals of the rehabilitation of patients with spinal cord injury &#40;SCI&#41; is the reintegration of the individual to their family&#44; social&#44; and work setting&#46; The objective of this study was to identify the factors that determine the discharge destination after a traumatic spinal cord injury&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material and methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">We conducted a retrospective descriptive study of 305 patients with SCI who completed the rehabilitation treatment at the spinal injury unit of Hospital Insular de Gran Canaria between 2001 and 2018&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">During the study period&#44; we observed an increase in the number of patients referred to long-term care centres&#44; from 9&#46;14&#37; between 2001 and 2010 to 18&#46;4&#37; between 2011 and 2018 &#40;p &#60; &#46;01&#41;&#46; Of 20 variables that presented a significant association with destination at discharge in the univariate study&#44; 7 presented a significant association in the multivariate study&#58; age &#40;OR&#58; 1&#46;05&#59; 95&#37; CI&#44; 1&#46;02-1&#46;08&#41;&#44; living with a partner &#40;OR&#58; 0&#46;26&#59; 95&#37; CI&#44; 0&#46;09-0&#46;76&#41;&#44; residing on another island &#40;OR&#58; 3&#46;57&#59; 95&#37; CI&#44; 1&#46;32-9&#46;63&#41;&#44; smoking &#40;OR&#58; 3&#46;44&#59; 95&#37; CI&#44; 1&#46;26-9&#46;44&#41;&#44; diabetes &#40;OR&#58; 6&#46;51&#59; 95&#37; CI&#44; 1&#46;46-29&#46;02&#41;&#44; history of psychiatric disorders &#40;OR&#58; 3&#46;79&#59; 95&#37; CI&#44; 1&#46;31-10&#46;93&#41;&#44; and scores on the Spinal Cord Independence Measure-III &#40;SCIM-III&#41; &#40;OR&#58; 0&#46;48&#59; 95&#37; CI&#44; 0&#46;33-0&#46;69&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Our findings identified advanced age&#44; living on the island of Tenerife&#44; not being married&#44; smoking&#44; type 2 diabetes mellitus&#44; history of psychiatric disorders&#44; and low SCIM-III scores as predictive factors of referral to a long-term care centre in patients with traumatic SCI in the Canary Islands&#46;</p></span>"
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Grado lesi&#243;n neur&#243;logica&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Descripci&#243;n cl&#237;nica&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">ASIA A&#46; Completa&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">No funci&#243;n sensitiva ni motora por debajo del nivel neurol&#243;gico incluyendo niveles S4-S5&#46;&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">Funci&#243;n sensitiva&#44; pero no motora&#44; por debajo del nivel neurol&#243;gico incluyendo niveles S4-S5&#46;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">ASIA C&#46; Incompleta&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Funci&#243;n motora conservada debajo del nivel neurol&#243;gico&#44; incluyendo niveles S4-S5&#46; M&#225;s de la mitad de los m&#250;sculos por debajo presentan un balance muscular menor a 3&#46;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">ASIA D&#46; Incompleta&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">Funci&#243;n motora conservada debajo del nivel neurol&#243;gico&#44; incluyendo niveles S4-S5&#46; La mitad de los m&#250;sculos por debajo presentan un balance muscular mayor a 3&#46;&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">Recuperaci&#243;n total de la funci&#243;n sensitiva y motora&#46;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60;&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Tenerife&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">66 &#40;21&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Gran Canaria&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">151 &#40;57&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Otra isla&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Estado Civil</span>&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">&#60;&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Soltero&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">119 &#40;39&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">105 &#40;40&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Casado&#47;pareja&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">128 &#40;49&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Separado&#47;divorciado&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">29 &#40;9&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">8 &#40;21&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">21 &#40;8&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Viudo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">11 &#40;3&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5 &#40;13&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">6 &#40;2&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Hijos</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0 &#40;0-2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1 &#40;0-2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0 &#40;0-2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;641&nbsp;\t\t\t\t\t\t\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="elsevierStyleItalic">Vivienda Previa</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \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">&#60;&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Vivienda propia&#44; viv&#237;a solo&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">63 &#40;21&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">16 &#40;41&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">47 &#40;18&#44;0&#41;&nbsp;\t\t\t\t\t\t\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>Vivienda conyugal&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">142 &#40;47&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">14 &#40;35&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">128 &#40;49&#44;0&#41;&nbsp;\t\t\t\t\t\t\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>Vivienda paterna&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">76 &#40;25&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3 &#40;7&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">73 &#40;28&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Vivienda hijos&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">3 &#40;1&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1 &#40;2&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2 &#40;0&#44;8&#41;&nbsp;\t\t\t\t\t\t\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>Vivienda otros familiares&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Vivienda amigos&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Otra&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Nivel Educacional</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sin estudios&#47;Primarios&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Secundarios&#47;Universitarios&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Situaci&#243;n Laboral</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60;&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Nada&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Estudiante&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Activo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">9 &#40;23&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3 &#40;7&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">8 &#40;3&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Jubilado&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">13 &#40;33&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">29 &#40;11&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Incapacidad&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">15 &#40;5&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4 &#40;10&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ama de casa&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">20 &#40;6&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3 &#40;7&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">17 &#40;6&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Tabaco</span>&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="" 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="" 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="" 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">0&#44;039&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"><span class="elsevierStyleHsp" style=""></span>Fumador diario&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">118 &#40;38&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23 &#40;57&#44;5&#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">95 &#40;35&#44;8&#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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Fumador ocasional&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;2&#44;6&#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">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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;3&#44;0&#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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ex-fumador&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">18 &#40;5&#44;9&#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">3 &#40;7&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15 &#40;5&#44;7&#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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No fumador&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">161 &#40;52&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14 &#40;35&#44;0&#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">147 &#40;55&#44;5&#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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Alcohol</span>&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="" 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="" 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="" 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">0&#44;005&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"><span class="elsevierStyleHsp" style=""></span>Grado t&#243;xico&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">35 &#40;11&#44;5&#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">11 &#40;27&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24 &#40;9&#44;1&#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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Diario&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">26 &#40;8&#44;5&#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">1 &#40;2&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25 &#40;9&#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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ocasional&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">163 &#40;53&#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">18 &#40;45&#44;0&#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">145 &#40;54&#44;7&#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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No bebedor&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">81 &#40;26&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 &#40;25&#44;0&#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">71 &#40;26&#44;8&#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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Drogas</span>&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="" 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="" 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="" 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">0&#44;429&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"><span class="elsevierStyleHsp" style=""></span>Duras&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23 &#40;7&#44;5&#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">3 &#40;7&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20 &#40;7&#44;5&#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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Blandas-no duras&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23 &#40;7&#44;5&#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">1 &#40;2&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22 &#40;8&#44;3&#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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No&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">259 &#40;84&#44;9&#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">36 &#40;90&#44;0&#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">223 &#40;84&#44;2&#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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&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">&#60;&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cateterismo intermitente&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Asistido V&#46; refleja&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1 &#40;2&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Asistido V&#46; arrefl&#233;xica&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">9 &#40;3&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Derivaci&#243;n permanente&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">65 &#40;22&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">29 &#40;74&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">36 &#40;14&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Control voluntario&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">90 &#40;30&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2 &#40;5&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60;&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>0-5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">68 &#40;23&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">24 &#40;61&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">44 &#40;17&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>6-10&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">28 &#40;9&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3 &#40;7&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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Información del artículo
ISSN: 02134853
Idioma original: Español
DOI:10.1016/j.nrl.2021.09.012
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