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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Severe trauma is regarded as one of the disorders with the greatest healthcare and economic impact in society today&#46; Worldwide&#44; it is the leading cause of mortality in young adults&#44; and involves the highest incidence of potential life years lost&#46; According to the World Health Organization &#40;WHO&#41; in its 2011 statistical report on data referred to 2008&#44;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">1</span></a> the mortality rate associated to trauma worldwide is 78 deaths&#47;100&#44;000 inhabitants&#44; ranging between 107 deaths&#47;100&#44;000 inhabitants in Africa and 63 deaths&#47;100&#44;000 inhabitants in Europe&#46; The main causes of trauma are traffic and work accidents&#44; while other causes comprise falls&#44; sports accidents&#44; etc&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The management of patients with severe trauma starts at the site of injury&#44; where the pre-hospital healthcare services play a key role&#46; This initial patient care has been protocolized through a series of recommendations that are regularly updated on the basis of scientific evidence&#8211;the reference of which is found in the methodology proposed by the Prehospital Trauma Life Support program&#44; which prioritizes treatment of the most life-threatening injuries at the trauma site&#44; and the Advanced Trauma Life Support &#40;ATLS&#41; program&#44; once the patient reaches the reference hospital&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">2</span></a> Following the pre-hospital phase&#44; initial in-hospital care<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">3</span></a> is mainly the responsibility of the Emergency Care Departments and Intensive Care Units &#40;ICUs&#41;&#46; Early identification of the factors related to severity and the adoption of appropriate management measures has a clear impact on the patient prognosis and possible sequelae&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The present study describes the management of severe trauma and polytraumatized patients at the three healthcare levels in the province of Salamanca &#40;Spain&#41;&#46; A description is provided of the different variables that influence the final outcome starting from the actual site of injury&#44; whether epidemiological or related to patient care&#44; including clinical&#44; laboratory test&#44; diagnostic and therapeutic parameters&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Patients and methods</span><p id="par0020" class="elsevierStylePara elsevierViewall">A retrospective descriptive study was made of the polytraumatized patients admitted to the ICU of Salamanca Hospital Complex during the years 2006&#8211;2011&#46; The data considered to be most relevant within each link of the patient care chain were collected by reviewing the patient case histories&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">-</span><p id="par0025" class="elsevierStylePara elsevierViewall">Epidemiological variables&#58; patient age&#44; gender&#44; type of accident &#40;traffic&#44; accidental fall &#60;50<span class="elsevierStyleHsp" style=""></span>cm or &#62;50<span class="elsevierStyleHsp" style=""></span>cm&#44; sports&#44; assault &#91;knife or gun wounds&#93;&#44; injuries caused by cattle&#44; and others&#41;&#44; origin &#40;pre-hospital or transferred from another hospital&#8211;fundamentally Avila or Zamora&#41;&#44; and personal history&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">-</span><p id="par0030" class="elsevierStylePara elsevierViewall">Pre-hospital and in-hospital emergency care clinical&#44; diagnostic and therapeutic variables&#58;<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">&#8226;</span><p id="par0035" class="elsevierStylePara elsevierViewall">First care&#44; form of transport and time to arrival in hospital&#58; basic life support&#44; advanced life support &#40;ALS&#41;&#44; medicalized helicopter&#44; others&#46;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">&#8226;</span><p id="par0040" class="elsevierStylePara elsevierViewall">Clinical particulars&#58; blood pressure &#40;BP&#41;&#44; heart rate&#44; oxygen saturation&#44; respiratory frequency&#44; initial Glasgow Coma Scale &#40;GCS&#41; score&#44; with the identification of verbal&#44; ocular and motor response and pupillary alterations &#40;anisocoria or non-reactive mydriasis&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">&#8226;</span><p id="par0045" class="elsevierStylePara elsevierViewall">Treatment&#58; oxygen therapy&#44; advanced airway management &#40;orotracheal intubation&#44; laryngeal mask&#44; Fastrach<span class="elsevierStyleSup">&#174;</span> or others&#41;&#44; venous access&#44; chest drain&#44; need for vasoactive drugs&#44; need for cardiopulmonary resuscitation&#44; and fluid therapy&#46;</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">&#8226;</span><p id="par0050" class="elsevierStylePara elsevierViewall">Diagnostic measures and timing&#58; plain X-rays of the chest and pelvis&#44; ECO-FAST&#44; computed tomography &#40;brain&#44; cervical&#44; thoracic or abdominopelvic&#41;&#44; laboratory tests and blood lactate measurements&#46;</p></li></ul></p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">-</span><p id="par0055" class="elsevierStylePara elsevierViewall">Variables in the ICU&#58;<ul class="elsevierStyleList" id="lis0015"><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">&#8226;</span><p id="par0060" class="elsevierStylePara elsevierViewall">Time to admission to the ICU from arrival in hospital&#44; and origin &#40;Emergency Care&#44; Radiology&#44; operating room&#44; other hospital&#44; or others&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">&#8226;</span><p id="par0065" class="elsevierStylePara elsevierViewall">Clinical and laboratory test data upon admission&#46;</p></li><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">&#8226;</span><p id="par0070" class="elsevierStylePara elsevierViewall">Evolutive data after 6 and 24<span class="elsevierStyleHsp" style=""></span>h&#58; water balance&#44; adrenalin dose &#40;if required&#41;&#44; transfusion of blood products and coagulation factors&#44; lactate&#44; and PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span> ratio&#46;</p></li><li class="elsevierStyleListItem" id="lsti0055"><span class="elsevierStyleLabel">&#8226;</span><p id="par0075" class="elsevierStylePara elsevierViewall">Complications&#58;<ul class="elsevierStyleList" id="lis0020"><li class="elsevierStyleListItem" id="lsti0060"><span class="elsevierStyleLabel">&#8728;</span><p id="par0080" class="elsevierStylePara elsevierViewall">Renal failure&#46;</p></li><li class="elsevierStyleListItem" id="lsti0065"><span class="elsevierStyleLabel">&#8728;</span><p id="par0085" class="elsevierStylePara elsevierViewall">Infections&#58; ventilator-associated pneumonia &#40;VAP&#41;&#44; catheter-related infections&#44; urinary infections&#44; central nervous system &#40;CNS&#41; infections&#44; abdominal infections&#44; or others&#46;</p></li></ul></p></li><li class="elsevierStyleListItem" id="lsti0070"><span class="elsevierStyleLabel">&#8226;</span><p id="par0090" class="elsevierStylePara elsevierViewall">Variables related to mechanical ventilation&#58; days of mechanical ventilation&#44; performance of tracheotomy in the ICU &#40;percutaneous or surgical&#41;&#44; transfer to ward with tracheotomy&#44; or decannulation in the ICU&#46;</p></li></ul></p></li><li class="elsevierStyleListItem" id="lsti0075"><span class="elsevierStyleLabel">-</span><p id="par0095" class="elsevierStylePara elsevierViewall">Evolutive parameters&#58;<ul class="elsevierStyleList" id="lis0025"><li class="elsevierStyleListItem" id="lsti0080"><span class="elsevierStyleLabel">&#8226;</span><p id="par0100" class="elsevierStylePara elsevierViewall">Days of stay in the ICU and in hospital&#46;</p></li><li class="elsevierStyleListItem" id="lsti0085"><span class="elsevierStyleLabel">&#8226;</span><p id="par0105" class="elsevierStylePara elsevierViewall">Death in the ICU or in the hospital ward&#46;</p></li><li class="elsevierStyleListItem" id="lsti0090"><span class="elsevierStyleLabel">&#8226;</span><p id="par0110" class="elsevierStylePara elsevierViewall">Severity scores&#58; Acute Physiology and Chronic Health Evaluation&#8211;II &#40;APACHE-II&#41;&#44; Injury Severity Score &#40;ISS&#41; and Extended Glasgow Outcome Scale &#40;GOS-E&#41; at hospital discharge&#44; and Glasgow Coma Scale &#40;GCS&#41; at discharge from the ICU and at hospital discharge&#46;</p></li></ul></p></li><li class="elsevierStyleListItem" id="lsti0095"><span class="elsevierStyleLabel">-</span><p id="par0115" class="elsevierStylePara elsevierViewall">Diagnostic variables&#58; types of trauma and acute management&#58;<ul class="elsevierStyleList" id="lis0030"><li class="elsevierStyleListItem" id="lsti0100"><span class="elsevierStyleLabel">&#8226;</span><p id="par0120" class="elsevierStylePara elsevierViewall">Traumatic brain injury &#40;TBI&#41;&#58; surgical treatment &#40;evacuating surgery&#44; decompressive craniectomy&#44; external ventricular drainage&#41;&#44; intracranial pressure &#40;ICP&#41; monitoring with attention to initial ICP and maximum measured ICP&#44; medical treatment &#40;hyperosmolar therapy&#44; barbiturate coma with recording of its start and duration&#41;&#44; and the Marshall classification&#46;</p></li><li class="elsevierStyleListItem" id="lsti0105"><span class="elsevierStyleLabel">&#8226;</span><p id="par0125" class="elsevierStylePara elsevierViewall">Other traumatisms&#58; spine and spinal cord injury&#44; and facial&#44; thoracic&#44; abdominal&#44; pelvic&#44; orthopedic and genitourinary trauma&#46;</p></li></ul></p></li></ul></p><p id="par0130" class="elsevierStylePara elsevierViewall">A Microsoft Access database was created for posterior statistical analysis using the SPSS statistical package&#44; MultBiplot and data mining methodology&#46; Multivariate binary logistic regression analysis was performed&#44; calculating the odds ratio &#40;OR&#41; of the factors considered pertinent in relation to mortality&#44; adjusted for age and gender&#44; with the corresponding 95&#37; confidence intervals &#40;95&#37;CI&#41;&#46; Likewise&#44; data mining was used&#44; applying different algorithms with the purpose of selecting the most influential parameters in relation to mortality&#44; along with other algorithms for the prediction of outcomes referred to death&#44; and the development of a series of decision trees&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Those patients in whom correct review of the case history was not possible due to problems locating the data or because of missing relevant information &#40;e&#46;g&#46;&#44; laboratory test results or hospital admission and discharge reports&#41; were excluded from the study&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Results</span><p id="par0140" class="elsevierStylePara elsevierViewall">During the study period we selected a total of 497 out of 562 possible patients diagnosed with severe trauma or polytraumatism&#46; The high percentage of excluded patients &#40;11&#46;2&#37;&#41; was fundamentally due to the fact that Salamanca Hospital Complex is the Neurosurgery reference center for the provinces of Avila and Zamora&#44; and the Chest Surgery reference center for Avila&#44; Zamora and Leon &#40;20&#37; of the patients in the study came from other provinces&#41;&#46; Consequently&#44; in many cases there were difficulties in obtaining the required pre-hospital and&#47;or hospital emergency care information&#44; and those patients for whom the data could not be obtained from reviewing the case histories were excluded from the study&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">The mean pre-hospital care time among the 359 patients for whom this parameter could be recorded was 62&#46;36<span class="elsevierStyleHsp" style=""></span>min&#44; with a standard deviation of 31&#46;1<span class="elsevierStyleHsp" style=""></span>min &#40;median 60<span class="elsevierStyleHsp" style=""></span>min&#41;&#46; Due to the peculiarities of the healthcare infrastructure of the province of Salamanca&#44; two well differentiated groups can be identified regarding the care times&#58; the first group corresponding to the city of Salamanca and the second to ALS of Bejar and Ciudad Rodrigo&#44; together with the helicopter of the Matacan airbase&#46; The difference in mortality rate between the two groups was 3&#46;6&#37; &#40;13&#37; vs 16&#46;5&#37;&#41;&#44; though this difference was not statistically significant in terms of an increased mortality risk in those patients for whom the time of transfer to the hospital center was longer&#58; OR 1&#46;399 &#40;0&#46;671&#8211;2&#46;892&#41;&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;778&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">The epidemiological characteristics&#44; causes of trauma and the types of traumatisms are reported in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; The high percentage of pedestrians run over in the traffic accident group is significant&#59; indeed&#44; in the population over 65 years of age&#44; this was found to be the main type of traffic accident &#40;48&#37; of the cases&#41;&#46; A patient age of over 65 years was associated to a three-fold increase in mortality risk in our series &#40;OR 3&#46;15 &#91;1&#46;781&#8211;5&#46;593&#93;&#41;&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#46; With regard to the different types of traumatisms&#44; TBI was the most frequent injury among those patients requiring admission to the ICU&#44; and was associated to a significant three-fold higher mortality risk &#40;OR 3&#46;095 &#91;1&#46;570&#8211;6&#46;099&#93;&#41;&#46; Forty-four percent of the patients presented an ISS<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>25 points&#44; this being associated to a mortality risk 28 times higher than in patients with ISS<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>25 points&#46; The overall mortality rate among the patients in our study was 14&#46;5&#37;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0155" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows the clinical variables studied in each link of the patient care chain and their relation to increased mortality risk according to the calculated odds ratio&#46; At all three levels&#44; neurological impairment as assessed by the GCS&#44; pupillary alterations and hypotension was related to increased mortality risk&#46; On jointly considering the pre-hospital&#44; emergency care and ICU data&#44; a GCS<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>8 was found to be associated to a 12&#46;97-fold increase in mortality risk &#40;OR 12&#46;969 &#91;3&#46;518&#8211;47&#46;812&#93;&#41;&#46; Regarding the therapeutic techniques used by the pre-hospital and emergency care services &#40;<a class="elsevierStyleCrossRefs" href="#tbl0015">Tables 3 and 4</a>&#41;&#44; increased in-hospital mortality risk was seen to be associated to a need for vasoactive drugs and lung isolation maneuvers at both care levels&#46; It should be mentioned that 4&#37; of the patients with GCS<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>8 reached the Emergency Care Department without lung isolation&#44; though no statistically significant association to increased mortality was observed&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0160" class="elsevierStylePara elsevierViewall">Among the in-hospital laboratory test parameters&#44; elevated lactate concentration was seen to be associated to increased mortality risk&#44; particularly when found to be persistently high &#40;&#62;4<span class="elsevierStyleHsp" style=""></span>mmol&#47;l&#41; over the first 24<span class="elsevierStyleHsp" style=""></span>h of management &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; The adoption of measures to ensure normal oxygenation&#44; ventilation and blood pressure values was related to a decreased mortality risk in the period covering pre-hospital to emergency care&#46; This trend was not observed upon admission to the ICU&#44; though many mediating factors could have been involved&#44; such as the time to admission to the ICU&#44; the origin of the patients&#44; the need for surgery before admission to the ICU&#44; etc&#46; The persistence of hypotension upon admission to the ICU was correlated to an almost four-fold higher mortality risk compared with hypotension upon admission to emergency care&#46; The administration of vasoactive drugs in the first 6<span class="elsevierStyleHsp" style=""></span>h of in-hospital care was associated to a more than 6-fold increase in mortality risk &#40;OR 6&#46;168 &#91;2&#46;598&#8211;14&#46;645&#93;&#41;&#44; and a positive water balance of over 2500<span class="elsevierStyleHsp" style=""></span>ml was associated to a three-fold increase in mortality risk &#40;OR 3&#46;842 &#91;2&#46;020&#8211;7&#46;305&#93;&#41;&#46; The use of colloids during admission to emergency care implied an almost three-fold increase in mortality risk &#40;OR 2&#46;910 &#91;1&#46;067&#8211;8&#46;036&#93;&#41;&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;029&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Traumatic brain injury</span><p id="par0165" class="elsevierStylePara elsevierViewall">As has been commented&#44; TBI is the most extreme representation of trauma requiring admission to the ICU&#44; and is associated to increased mortality&#46; Of the patients diagnosed with TBI in our study &#40;282 subjects&#41;&#44; information referred to the GCS score was available on 275 &#40;97&#46;5&#37;&#41;&#46; In this regard&#44; severe TBI &#40;GCS<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>8&#41; was more frequent&#44; representing 54&#46;2&#37; of the patients&#44; while moderate TBI &#40;GCS 9&#8211;13&#41; accounted for 14&#46;9&#37; and mild TBI &#40;GCS 14&#8211;15&#41; represented 30&#46;9&#37;&#46; In relation to the Marshall classification &#40;<a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a>&#41;&#44; information was available on 97&#46;9&#37; of the patients with TBI&#8211;the most frequent lesions corresponding to type <span class="elsevierStyleSmallCaps">ii</span> &#40;39&#46;7&#37;&#41;&#44; while the lesions with a poorer prognosis &#40;type <span class="elsevierStyleSmallCaps">iv</span>&#41; and cases involving non-evacuated mass accounted for 2&#46;8&#37; and 9&#46;2&#37;&#44; respectively&#46; Of the patients for whom information regarding the GCS was available&#44; it can be concluded that a decrease in GCS score was associated to a significant 29&#46;3-fold increase in the risk of mortality in the ICU and a 13-fold increase in the risk of mortality in hospital&#44; in patients with GCS<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>8 &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia><p id="par0170" class="elsevierStylePara elsevierViewall">Regarding the specific monitoring and treatment measures during the stay in the ICU among patients with TBI&#44; data that referred to intracranial pressure &#40;ICP&#41; were available in 88 patients &#40;31&#46;2&#37;&#41;&#44; with a mean initial ICP of 23&#46;3<span class="elsevierStyleHsp" style=""></span>mmHg &#40;standard deviation 15&#46;1<span class="elsevierStyleHsp" style=""></span>mmHg&#41; and a mean maximum ICP of 37&#46;6<span class="elsevierStyleHsp" style=""></span>mmHg &#40;standard deviation 32<span class="elsevierStyleHsp" style=""></span>mmHg&#41;&#46; If intracranial hypertension is defined as ICP<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>20<span class="elsevierStyleHsp" style=""></span>mmHg&#44; then 75&#37; of the monitored patients had intracranial hypertension&#46; In relation to the treatment of intracranial hypertension&#44; all of the patients initially received sedoanalgesia and relaxation&#44; while 50&#37; on some occasion received hyperosmolar treatment in the form of 20&#37; mannitol or 7&#46;5&#37; hypertonic saline solution&#46; When these measures failed to control ICP&#44; 5&#37; of the patients with TBI were subjected to decompressive craniectomy&#44; while 22 patients &#40;7&#46;8&#37;&#41; underwent barbiturate coma induction through the administration of thiopental sodium&#46; The mean time to the induction of barbiturate coma was 38&#46;9<span class="elsevierStyleHsp" style=""></span>h&#44; with a standard deviation of 27&#46;91<span class="elsevierStyleHsp" style=""></span>h and a mean duration of 8&#46;75 days &#40;standard deviation 3&#46;47&#41;&#46; External ventricular drainage was only used in two patients &#40;0&#46;7&#37;&#41;&#46; Both the initial ICP and a maximum ICP of &#62;30<span class="elsevierStyleHsp" style=""></span>mmHg were associated to increased mortality risk and a poorer neurological outcome &#8211; though the results were not statistically significant &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46; In turn&#44; barbiturate coma and decompressive craniectomy were associated to a significantly poorer neurological outcome &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#44; but were not correlated to increased mortality risk either in the ICU or in hospital&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Outcome variables and complications in the ICU</span><p id="par0175" class="elsevierStylePara elsevierViewall">A total of 334 patients required mechanical ventilation&#44; with a mean duration of 9&#46;27 days&#46; The mortality rate among the patients subjected to mechanical ventilation was 15&#46;9&#37; in the ICU and 19&#46;16&#37; in hospital&#46; Of the total patients&#44; 69 underwent tracheotomy during admission to the ICU &#40;13&#46;9&#37;&#41;&#44; with the use of percutaneous tracheotomy in 62 of them &#40;89&#46;9&#37;&#41;&#46; Of the tracheotomized patients&#44; 24 were decannulated in the ICU &#40;34&#46;8&#37;&#41;&#44; and one patient subsequently died in the ICU and another in the hospital ward&#46; Fourteen percent of the remaining 43 patients &#40;62&#46;3&#37;&#41; who were moved to the hospital ward with the tracheotomy cannula subsequently died&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">In relation to the complications of the patients during admission to the ICU&#44; particular mention must be made of infectious processes&#46; Specifically&#44; the most frequent infections were of a respiratory nature&#44; with ventilator-associated pneumonia &#40;VAP&#41; in 19&#46;5&#37; of the cases&#8211;mostly of early onset &#40;within the first 5&#8211;7 days of admission&#41;&#8211;followed by catheter-related infections &#40;3&#46;8&#37;&#41;&#46; On considering only TBI&#44; the proportion of VAP was found to increase to 21&#46;5&#37;&#46; The rest of the infections had a lesser incidence and corresponded to urinary infections&#44; postoperative abdominal infections and central nervous system infections&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">HJ-Biplot</span><p id="par0185" class="elsevierStylePara elsevierViewall">The HJ Biplot statistical analysis using the MultBiplot program<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">4</span></a> yielded a graphic representation &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41; of the different study variables&#46; Through determination of the length and angulation between variables represented in vector form&#44; we can determine the greater or lesser association between variables&#46; On taking death as the reference variable&#44; the vectors with a more acute angulation were seen to correspond to the variables anisocoria and the need for lung isolation by the pre-hospital care service&#46; The GCS was positioned in the plot opposite to death in the ICU &#40;forming an angle of 180&#176; with death&#41;&#44; i&#46;e&#46;&#44; the GCS score was inversely related to death &#40;lesser scores being associated to increased mortality&#41;&#46; In turn&#44; the persistence over time of lactate levels of &#62;4<span class="elsevierStyleHsp" style=""></span>mmol&#47;l was associated to mortality&#44; as represented by a more acute angulation of lactate &#62;4<span class="elsevierStyleHsp" style=""></span>mmol&#47;l after 6<span class="elsevierStyleHsp" style=""></span>h of admission to the ICU &#40;L6hicu&#41; versus lactate upon admission to the ICU &#40;L&#41; or lactate concentration in emergency care &#40;Lemer&#41;&#46; Some variables appear coded in less intense color&#44; indicating that they are more poorly represented in the plot&#44; though tending to be associated to mortality in the ICU&#44; such as patient age&#44; pre-hospital care time&#44; and the need for tracheotomy&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Data mining</span><p id="par0190" class="elsevierStylePara elsevierViewall">Lastly&#44; on applying data mining algorithms&#44;<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">5&#44;6</span></a> the characteristics with the greatest repercussion in terms of mortality were found to be TBI and its associated variables&#44; such as the GCS score &#40;fundamentally referred to its motor component&#41;&#44; or maximum ICP &#40;<a class="elsevierStyleCrossRef" href="#tbl0030">Table 6</a>&#41;&#46; Following these variables&#44; we also identified the need for vasoactive drugs at the start of patient care&#44; the transfusion of red cell concentrates&#44; lactate &#62;4<span class="elsevierStyleHsp" style=""></span>mmol&#47;l after 24<span class="elsevierStyleHsp" style=""></span>h of stay in the ICU&#44; patient age&#44; and the days on mechanical ventilation&#46; Posteriorly&#44; different classification algorithms were applied to construct decision trees such as the J48 pruned tree for death&#44; among others&#44; with a view to develop outcome predictor models&#46; As can be seen in <a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#44; the most determinant elements in terms of mortality were the TBI-related variables&#44; followed by other parameters such as the days of admission&#44; patient age or the days on mechanical ventilation&#46; Of all the applied algorithms&#44; that exhibiting the greatest precision in the global patients was the Adaboost multi-classifier with J48 as base classifier &#40;92&#37;&#41;&#46;</p><elsevierMultimedia ident="tbl0030"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Discussion</span><p id="par0195" class="elsevierStylePara elsevierViewall">As has been evidenced by many studies&#44; one of the factors most closely related to mortality in severe trauma patients is the presence of TBI&#46; The prognosis of such patients can be determined from the pupillary alterations and GCS score&#44;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">7&#8211;9</span></a> both of which were identified by the statistical tests used in our study&#46; In order to improve the prognosis of patients with TBI&#44; the Brain Trauma Foundation guidelines establish a series of initial management principles based on scientific evidence&#46;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">10&#44;11</span></a> Regarding therapeutic maneuvering in the general management of polytraumatized patients&#44; adherence to the recommendations of the Advanced Trauma Life Support &#40;ATLS&#41; program results in lowered mortality&#44; as affirmed by van Olden et al&#46; in 2004&#44;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">12</span></a> though Pfeifer et al&#46; in 2009&#44;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">13</span></a> in a study on the evolution of such mortality over 30 years&#44; concluded that the mentioned decrease is attributable to a reduction in deaths due to bleeding&#44; while deaths due to TBI or multiorgan failure remain stable&#46; This affirmation was based on a systematic review of different studies&#44; with no type of meta-analysis&#44; reflecting a mortality rate in the reviewed studies of between 9 and 49&#46;8&#37;&#46; Our own data are at the lower limit of this range&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">The determination of lactate concentration has been introduced in recent years for the assessment of shock&#46;<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">14&#8211;16</span></a> Despite controversy about the usefulness of lactate in assessing the clinical situation of a patient and the success of resuscitation&#44; many studies speak in favor of the determination of this parameter&#46; In relation to this point&#44; Blow in 1999<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">17</span></a> indicated that patients in whom the lactate levels could not be reduced or normalized within the first 24<span class="elsevierStyleHsp" style=""></span>h experienced greater mortality&#46; This is why this crucial first day is referred to as the &#8220;silver day&#8221;&#46; With a view to minimizing this problem&#44; therapeutic maneuvering is indicated&#44; e&#46;g&#46;&#44; early surgery or intensive resuscitation&#44; along with other management measures that could be encompassed within what is known as &#8220;damage control&#8221;&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">18</span></a></p><p id="par0205" class="elsevierStylePara elsevierViewall">The patient population in our setting is older than in other studies found in the literature&#46;<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">19&#44;20</span></a> This is mainly due to aging of the population in the region of Castilla y Le&#243;n&#44; and particularly in the province of Salamanca&#46; No major differences were observed as regards the causes of trauma with respect to other studies&#44; except for a small increase in the number of falls&#8211;this fundamentally being explained by the larger presence of individuals over 65 years of age in our series&#46; The mortality rate in our study is consistent with the figures published elsewhere &#40;11&#8211;15&#37;&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">19&#8211;22</span></a></p><p id="par0210" class="elsevierStylePara elsevierViewall">Reducing the patient care and transfer times until definitive admission to the ICU is important for improving survival&#46; As has been reflected in a study comparing the outcomes of trauma in the urban versus the rural setting&#44;<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">23&#44;24</span></a> differences in the time of transfer to hospital are associated to increased mortality&#44; without differences in terms of the ultimate outcome between the two groups once the patients reach the hospital&#46; Some studies have considered separate groups corresponding to urban care and rural care&#46; In our series the distinction was referred to times of transfer to hospital&#44; with the documentation of a tendency toward greater mortality in the case of longer transfer times&#46; Those patients who present some severity criterion upon admission to emergency care stand to benefit from early assessment by an experienced trauma team&#44; as has been evidenced by a number of authors&#59; our efforts therefore should focus on greater protocolization based on already established recommendations that have been shown to be effective&#46;<a class="elsevierStyleCrossRefs" href="#bib0275"><span class="elsevierStyleSup">25&#8211;28</span></a> Such protocolization exerts a decisive influence in reducing the times to definitive patient care&#46;</p><p id="par0215" class="elsevierStylePara elsevierViewall">The development of registries in Intensive Care Medicine contributes to improve the care of patients requiring admission to the ICU mainly through knowledge of the characteristics and therapeutic maneuvers depending on the type of disease condition involved&#46; Polytraumatized patients constitute an important group of individuals requiring admission to the ICU&#59; in our setting they represent 15&#46;6&#37; of all emergency admissions and 7&#46;6&#37; of the total admissions to the ICU&#46; In recent years&#44; both national and European trauma registries have been developed&#46;<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">20&#44;29</span></a> In Spain&#44; a new national polytrauma registry is under development&#44;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">30</span></a> and the present study offers a possible reference for establishing comparisons&#46;</p><p id="par0220" class="elsevierStylePara elsevierViewall">The limitations of this study may be the fact that it is a single-center initiative involving a retrospective review&#44; with the inclusion of patients who were referred to the Salamanca Hospital Complex from other provinces&#46; Nevertheless&#44; we identified and eliminated the possible confounding factors&#44; and recorded no statistically significant differences in mortality according to the origin of the studied variables&#46;</p><p id="par0225" class="elsevierStylePara elsevierViewall">In conclusion&#44; the use of less common statistical techniques such as data mining or MultBiplot allowed identification of the variables with the greatest influence upon mortality among polytraumatized patients&#8211;the results being consistent with those produced by classical statistical methods&#46; In our study&#44; the variables related to the presence of TBI were seen to be important&#44; though lactate concentration was also important in terms of patient prognosis&#46; In effect&#44; this parameter is relevant both for assessing the hemodynamic situation of polytraumatized patients and as an endpoint for monitoring the efficacy of the adopted resuscitation measures&#46; In turn&#44; the present study points to the need for correct protocolization in order to shorten the patient care times&#8211;which exert a decisive influence upon patient prognosis and mortality&#8211;and the need for registries which can be used to define possible measures and opportunities for improving patient care&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Financial support</span><p id="par0230" class="elsevierStylePara elsevierViewall">There has been no partial or full financial support of this study&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Conflicts of interest</span><p id="par0235" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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          "titulo" => "Introduction"
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              "titulo" => "Traumatic brain injury"
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    "fechaRecibido" => "2014-02-28"
    "fechaAceptado" => "2014-06-12"
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          "clase" => "keyword"
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            0 => "Polytraumatism"
            1 => "Critical care"
            2 => "Population registry"
            3 => "Lactate"
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          "palabras" => array:4 [
            0 => "Politraumatismos"
            1 => "Cuidados intensivos"
            2 => "Registros de poblaci&#243;n"
            3 => "Lactato"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To identify factors related to mortality in adult trauma patients&#44; analyzing the clinical&#44; epidemiological and therapeutic characteristics at the pre-hospital levels&#44; in the Emergency Care Department and in Intensive Care&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Design</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A retrospective&#44; longitudinal descriptive study was carried out&#46; Statistical analysis was performed using SPSS&#44; MultBiplot and data mining methodology&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Setting</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Adult multiple trauma patients admitted to the Salamanca Hospital Complex &#40;Spain&#41; from 2006 to 2011&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Main variables of interest</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Demographic variables&#44; clinical&#44; therapeutic and analytical data from the injury site to ICU admission&#46; Evolution from ICU admission to hospital discharge&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Results</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">A total of 497 patients with a median age of 45&#46;5 years were included&#46; Males predominated &#40;76&#46;7&#37;&#41;&#46; The main causes of injury were traffic accidents &#40;56&#46;1&#37;&#41;&#44; precipitation &#40;18&#46;4&#37;&#41; and falls &#40;11&#37;&#41;&#46; The factors with the strongest association to increased mortality risk &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41; were age<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>65 years &#40;OR 3&#46;15&#41;&#44; head injuries &#40;OR 3&#46;1&#41;&#44; pupillary abnormalities &#40;OR 113&#46;88&#41;&#44; level of consciousness according to the Glasgow Coma Scale<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>8 &#40;OR 12&#46;97&#41;&#44; and serum lactate levels<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>4<span class="elsevierStyleHsp" style=""></span>mmol&#47;L &#40;OR 9&#46;7&#41;&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conclusions</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">The main risk factors identified in relation to the prognosis of trauma patients are referred to the presence of head injuries&#46; Less widely known statistical techniques such as data mining or MultBiplot also underscore the importance of other factors such as lactate concentration&#46; Trauma registries help assess the healthcare provided&#44; with a view to adopt measures for improvement&#46;</p></span>"
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            "titulo" => "Objective"
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            "titulo" => "Design"
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        "titulo" => "Resumen"
        "resumen" => "<span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Objetivo</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Identificar los factores relacionados con la mortalidad de los pacientes adultos politraumatizados&#44; analizar las caracter&#237;sticas cl&#237;nicas&#44; epidemiol&#243;gicas y terap&#233;uticas en los niveles prehospitalario&#44; Servicio de Urgencias y Cuidados Intensivos&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Dise&#241;o</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Estudio retrospectivo&#44; longitudinal y descriptivo&#46; An&#225;lisis estad&#237;stico a trav&#233;s del programa SPSS&#44; MultBiplot y la metodolog&#237;a de miner&#237;a de datos&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">&#193;mbito</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Pacientes adultos politraumatizados ingresados en el Complejo Hospitalario de Salamanca entre los a&#241;os 2006 y 2011&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Variables de inter&#233;s principales</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Variables demogr&#225;ficas&#44; cl&#237;nicas&#44; terap&#233;uticas y anal&#237;ticas desde el lugar del accidente hasta el ingreso en la UCI&#46; Variables evolutivas durante el ingreso en la UCI y hasta el alta hospitalaria&#46;</p></span> <span id="abst0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Resultados</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Se incluy&#243; a 497 pacientes&#44; con una mediana de edad 45&#44;5 a&#241;os&#46; Predominio de varones &#40;76&#44;7&#37;&#41;&#46; La causa principal del traumatismo fueron los accidentes de tr&#225;fico &#40;56&#44;1&#37;&#41;&#44; precipitaciones &#40;18&#44;4&#37;&#41; y ca&#237;das &#40;11&#37;&#41;&#46; Los factores con mayor asociaci&#243;n a un incremento del riesgo de mortalidad &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41; fueron la edad &#62; 65 a&#241;os &#40;OR 3&#44;15&#41;&#44; el traumatismo craneoencef&#225;lico &#40;OR 3&#44;1&#41;&#44; las alteraciones pupilares &#40;OR 113&#44;88&#41;&#44; el nivel de consciencia seg&#250;n la escala de Glasgow &#8804; 8 &#40;OR 12&#44;97&#41; y las cifras de lactato &#62; 4<span class="elsevierStyleHsp" style=""></span>mmol&#47;L &#40;OR 9&#44;7&#41;&#46;</p></span> <span id="abst0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Conclusiones</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Los principales factores de riesgo identificados en relaci&#243;n con el pron&#243;stico de los pacientes politraumatizados son los relacionados con la presencia de traumatismo craneoencef&#225;lico&#46; Mediante la utilizaci&#243;n de distintas t&#233;cnicas estad&#237;sticas menos conocidas como la miner&#237;a de datos o el MultBiplot tambi&#233;n se destaca la importancia de otros factores como el lactato&#46; Los registros de traumatismos ayudan a conocer la asistencia sanitaria realizada para poder establecer medidas de mejora&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Gonz&#225;lez-Robledo J&#44; Mart&#237;n-Gonz&#225;lez F&#44; Moreno-Garc&#237;a M&#44; S&#225;nchez-Barba M&#44; S&#225;nchez-Hern&#225;ndez F&#46; Factores pron&#243;sticos relacionados con la mortalidad del paciente con trauma grave&#58; desde la atenci&#243;n prehospitalaria hasta la Unidad de Cuidados Intensivos&#46; Med Intensiva&#46; 2015&#59;39&#58;412&#8211;421&#46;</p>"
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">Males</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">76&#46;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">Females</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">23&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">Mean age</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">47&#46;7 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleBold">Cause of trauma</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Traffic</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">56&#46;1&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Car&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">62&#46;18&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Run over&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17&#46;39&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Motorcycle&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&#46;99&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Bicycle&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;86&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Others&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;58&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Fall</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#62;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">50</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">cm</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18&#46;4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Fall</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#60;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">50</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">cm</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Others</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14&#46;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleBold">Type of trauma</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">TBI</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">56&#46;74&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Spinal-spinal cord</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">23&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Thoracic</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">49&#46;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Abdominal</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">23&#46;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Pelvic</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&#46;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Orthopedic</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">41&#46;4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Epidemiological characteristics&#44; and causes and types of trauma&#46;</p>"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Percentage&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">OR &#40;95&#37;CI&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>-value&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Pre-hospital clinical variables</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>BP<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>90<span class="elsevierStyleHsp" style=""></span>mmHg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&#46;6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;53 &#40;1&#46;10&#8211;5&#46;80&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;029&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>HR<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>100<span class="elsevierStyleHsp" style=""></span>bpm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">32&#46;71&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;10 &#40;0&#46;55&#8211;2&#46;21&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;791&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>SatO2<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>80&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14&#46;78&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;52 &#40;0&#46;70&#8211;3&#46;32&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;291&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>GCS<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26&#46;12&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#46;09 &#40;4&#46;82&#8211;21&#46;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Anisocoria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;27&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;71 &#40;0&#46;91&#8211;8&#46;07&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;073&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Mydriasis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;9&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">91&#46;64 &#40;10&#46;90&#8211;770&#46;59&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Emergency care clinical variables</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>BP<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>90<span class="elsevierStyleHsp" style=""></span>mmHg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#46;46&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;32 &#40;1&#46;04&#8211;5&#46;18&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;040&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>HR<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>100<span class="elsevierStyleHsp" style=""></span>bpm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27&#46;77&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;76 &#40;0&#46;92&#8211;3&#46;37&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;088&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>SatO2<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>80&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;63&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;01 &#40;0&#46;36&#8211;2&#46;81&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;997&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>GCS<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17&#46;10&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&#46;52 &#40;5&#46;81&#8211;31&#46;45&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Anisocoria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;84&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;16 &#40;1&#46;69&#8211;10&#46;24&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;002&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Mydriasis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;82&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">219&#46;75 &#40;26&#46;25&#8211;1&#46;839&#46;27&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">ICU clinical variables</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>BP<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>90<span class="elsevierStyleHsp" style=""></span>mmHg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#46;84&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#46;16 &#40;3&#46;88&#8211;21&#46;65&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>SatO2<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>80&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;23&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;96 &#40;1&#46;16&#8211;7&#46;52&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;023&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>GCS<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21&#46;73&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18&#46;01 &#40;7&#46;48&#8211;43&#46;36&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Anisocoria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;23&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;81 &#40;1&#46;11&#8211;7&#46;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;029&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Mydriasis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;82&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">48&#46;15 &#40;12&#46;34&#8211;187&#46;92&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Binary logistic regression analysis of the most significant clinical variables at pre-hospital level&#44; in emergency care&#44; and in the ICU&#44; in relation to hospital mortality&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Hospital death</th><th class="td" title="table-head  " align="left" valign="top" scope="col">OR &#40;95&#37;CI&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col"><span class="elsevierStyleItalic">p</span>-value&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Airway&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">115 &#40;77&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">33 &#40;22&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;47 &#40;1&#46;95&#8211;6&#46;16&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Venous access&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">302 &#40;85&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">52 &#40;14&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;34 &#40;0&#46;73&#8211;2&#46;46&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;348&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Thoracic drainage&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12 &#40;70&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;29&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;60 &#40;0&#46;82&#8211;8&#46;29&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;106&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">CPR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;28&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;71&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21&#46;85 &#40;3&#46;73&#8211;128&#46;01&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Vasoactive drugs&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;36&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7 &#40;63&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&#46;12 &#40;2&#46;89&#8211;42&#46;80&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                0 => "xTab920015.png"
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        ]
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          "en" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Multivariate binary logistic regression analysis of the pre-hospital techniques in relation to hospital mortality&#44; adjusted for age and gender&#46;</p>"
        ]
      ]
      6 => array:7 [
        "identificador" => "tbl0020"
        "etiqueta" => "Table 4"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
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        "tabla" => array:1 [
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            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Hospital death</th><th class="td" title="table-head  " align="left" valign="top" scope="col">OR &#40;95&#37;CI&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col"><span class="elsevierStyleItalic">p</span>-value&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Airway&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">42 &#40;73&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15 &#40;26&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;16 &#40;1&#46;07&#8211;4&#46;34&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;032&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Thoracic drainage&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13 &#40;92&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;7&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;79 &#40;0&#46;09&#8211;6&#46;83&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;834&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Vasoactive drugs&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;27&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8 &#40;72&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26&#46;57 &#40;5&#46;88&#8211;119&#46;98&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Red cell conc&#46;<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">61 &#40;87&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9 &#40;12&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;66 &#40;1&#46;08&#8211;6&#46;53&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;033&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Fluid therapy<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>2000<span class="elsevierStyleHsp" style=""></span>ml&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">38 &#40;92&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;7&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;60 &#40;0&#46;16&#8211;2&#46;27&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;449&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Colloids&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">56 &#40;83&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11 &#40;16&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;91 &#40;1&#46;12&#8211;7&#46;59&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;029&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">Multivariate binary logistic regression analysis of the therapeutic and fluid therapy measures in emergency care in relation to hospital mortality&#44; adjusted for age and gender&#46;</p>"
        ]
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      7 => array:7 [
        "identificador" => "tbl0025"
        "etiqueta" => "Table 5"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Frequency&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Percentage&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Death&#47;poor outcome&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Type I&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">51&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#37;&#47;10&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Type II&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">112&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">39&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&#37;&#47;11&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Type III&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">17&#37;&#47;43&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Type IV&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Evacuated mass&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14&#37;&#47;33&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Non-evacuated mass&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">80&#37;&#47;80&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">282&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20&#46;2&#37;&#47;25&#46;9&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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        "descripcion" => array:1 [
          "en" => "<p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">Marshall classification of the patients with traumatic brain injury&#46; Description of the patients that died or presented a poor neurological outcome &#40;persistent vegetative state or severe disability&#41; according to the classification&#44; based on the Extended Glasgow Outcome Scale at hospital discharge&#46;</p>"
        ]
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      8 => array:7 [
        "identificador" => "tbl0030"
        "etiqueta" => "Table 6"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
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        "tabla" => array:1 [
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            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">0&#46;3703155&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">64 TBI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">0&#46;1373812&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">17 Poorer total GCS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">0&#46;0849137&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">48 GCS ICU&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">0&#46;0686669&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">49 GCS ICU V&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">0&#46;0592733&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">73 Maximum ICP&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">44 Pre-ICU origin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">0&#46;0557942&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50 GCS ICU M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">0&#46;0468255&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">31 Brain CAT Emer&#46; time&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">0&#46;0461143&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">113 Days MV&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">0&#46;0447293&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">118 Days hospital admission&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">0&#46;03866&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">71 Monitoring ICP&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">72 Initial ICP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">0&#46;0377903&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">30 Brain CAT Emer&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">0&#46;0366105&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100 NA max&#46; 24<span class="elsevierStyleHsp" style=""></span>h&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">0&#46;0362324&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">83 Tx abdominal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">0&#46;0358942&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">0&#46;0352626&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16 GCS Emer&#46;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">95 Red cell conc&#46; 6<span class="elsevierStyleHsp" style=""></span>h&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">117 Days admission ICU&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">0&#46;0276422&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">92 Balance 6<span class="elsevierStyleHsp" style=""></span>h&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">94 NA max&#46; 6<span class="elsevierStyleHsp" style=""></span>h&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">65 Evacuating surgery&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">98 Balance 24<span class="elsevierStyleHsp" style=""></span>h&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">0&#46;0237734&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">51 GCS ICU O&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">19 Non-reactive mydriasis Emer&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">0&#46;0212844&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 Origin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">0&#46;0179667&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">82 Thoracic drainage ICU&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">0&#46;0165572&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">0&#46;0159594&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">84 Laparotomy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">0&#46;0157081&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">40 Crystalloids Emer&#46;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">29 ECO FAST Emer&#46; time&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">26 Chest Rx Emer&#46;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">28 ECO FAST Emer&#46;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">87 Tx pelvic&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">32 TAC thorax&#47;abd&#46; Emer&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">0&#46;0127884&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">80 Tx thorax&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">0&#46;012545&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">86 Tx solid organ&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">0&#46;0122175&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">79 Tx facial&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">0&#46;0121557&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4 Out-hospital&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">0&#46;0119424&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">68 Barbiturate coma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">0&#46;0104189&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">53 Non-reactive mydriasis ICU&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                            3 => "J&#46;P&#46; Kolb"
                            4 => "J&#46;R&#46; Izbicki"
                            5 => "A&#46;H&#46; Ruecker"
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                          "etal" => false
                          "autores" => array:3 [
                            0 => "S&#46; Jain"
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                        "paginaInicial" => "598"
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                          "etal" => false
                          "autores" => array:5 [
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                            1 => "F&#46;J&#46; Rubio-Gil"
                            2 => "J&#46;C&#46; Mart&#237;n-Corral"
                            3 => "L&#46;A&#46; Marcos-Prieto"
                            4 => "J&#46; Gonz&#225;lez-Robledo"
                          ]
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