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Effect of the timing of admission upon patient prognosis in the Intensive Care Unit: On-hours versus off-hours
Efecto del momento de ingreso sobre el pronóstico de los pacientes en la Unidad de Cuidados Intensivos: on-hours vs. off-hours
A. Abella, C. Hermosa, V. Enciso, I. Torrejón, R. Molina, I. Salinas, M. Díaz, T. Mozo, F. Gordo
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Servicio de Medicina Intensiva, Hospital Universitario del Henares, Coslada, Madrid, Spain
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Abella, C. Hermosa, V. Enciso, I. Torrejón, R. Molina, I. Salinas, M. Díaz, T. Mozo, F. Gordo" "autores" => array:9 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Abella" ] 1 => array:2 [ "nombre" => "C." "apellidos" => "Hermosa" ] 2 => array:2 [ "nombre" => "V." "apellidos" => "Enciso" ] 3 => array:2 [ "nombre" => "I." "apellidos" => "Torrejón" ] 4 => array:2 [ "nombre" => "R." "apellidos" => "Molina" ] 5 => array:2 [ "nombre" => "I." "apellidos" => "Salinas" ] 6 => array:2 [ "nombre" => "M." "apellidos" => "Díaz" ] 7 => array:2 [ "nombre" => "T." "apellidos" => "Mozo" ] 8 => array:4 [ "nombre" => "F." "apellidos" => "Gordo" "email" => array:1 [ 0 => "fgordo5@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Medicina Intensiva, Hospital Universitario del Henares, Coslada, Madrid, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Efecto del momento de ingreso sobre el pronóstico de los pacientes en la Unidad de Cuidados Intensivos: <span class="elsevierStyleItalic">on-hours</span> vs. <span class="elsevierStyleItalic">off-hours</span>" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 756 "Ancho" => 1561 "Tamanyo" => 45470 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Histogram showing the distribution of patient admissions according to work shift (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.01).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">In general, the organization of hospital activity in our setting is based on work shifts. In this regard, the morning and afternoon shifts concentrate most of the medical team and scheduled activities, while the night shift, weekends and holidays are fundamentally attended by teams on duty. In some cases, the way in which hospital activities are organized can lead to changes in the prognosis of some patients, particularly those in critical condition.<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">1–3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">A number of hypothesis have been proposed to explain the differences in prognosis conditioned to the timing or circumstances of patient admission. One possible explanation is that a poorer prognosis may result from a lower personnel/patient ratio, less experienced specialists, intensivists on call and not physically present in the Unit, or even tiredness of the medical team in certain work shifts.<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">4–6</span></a> Other hypotheses point to possibly greater severity among patients who are admitted during the night or on weekends.<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">7</span></a> A relationship has also been described between a poorer prognosis and patient admission during the morning clinical round,<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">8,9</span></a> though this has not been confirmed in the study published by Bisbal et al.<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">10</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The working hypothesis in this study is that there is a difference in mortality among patients admitted to the Intensive Care Unit (ICU) depending on the time of day at which admission takes place.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Specifically, the present study evaluates the repercussions of the timing of admission to the ICU upon patient prognosis in an ICU based on the “ICU without walls” model<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">11–13</span></a> of proactive early detection of patients at risk in hospital but outside the ICU.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Material and methods</span><p id="par0025" class="elsevierStylePara elsevierViewall">A prospective, non-interventional observational cohort study was carried out, involving patients consecutively admitted to an adult polyvalent medical-surgical ICU with 8 beds in a 210-bed second-level hospital.</p><p id="par0030" class="elsevierStylePara elsevierViewall">We included all the patients admitted to the Unit in the course of a three-year period from January 2010 to December 2012, excluding those subjects coming from the operating room after scheduled surgery. In the case of patients readmitted to the ICU, we only considered the first admission.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The activity of the intensivists during the study period was distributed as follows:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1.</span><p id="par0040" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Daily morning shift</span>: from 8 a.m. to 3 p.m., with the presence of the entire Unit personnel members (except those coming off duty and those who worked during the afternoon shift of the previous day). The “ICU without walls” activities are conducted during this shift.</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2.</span><p id="par0045" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Daily afternoon shift</span>: from 3 p.m. to 10 p.m., with the presence of two intensivists.</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3.</span><p id="par0050" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Night shift</span>, from 10 p.m. to 8 a.m., <span class="elsevierStyleItalic">weekends</span> (Saturdays and Sundays) and <span class="elsevierStyleItalic">holidays</span>, with the presence of a single intensivist on duty, along with the usual personnel on duty in the rest of the hospital.</p></li></ul></p><p id="par0055" class="elsevierStylePara elsevierViewall">To the effects of analysis, the patients were distributed into two groups:<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">1.</span><p id="par0060" class="elsevierStylePara elsevierViewall">A first group, referred to as <span class="elsevierStyleItalic">on-hours</span>, involving the patients admitted during the daily morning and afternoon shifts (shifts 1 and 2).</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">2.</span><p id="par0065" class="elsevierStylePara elsevierViewall">A second group, referred to as <span class="elsevierStyleItalic">off-hours</span>, involving the patients admitted during the night shift, weekends and holidays (shift 3).</p></li></ul></p><p id="par0070" class="elsevierStylePara elsevierViewall">An analysis was made of demographic parameters (age, gender), patient origin (emergency care, hospital admission ward, operating room), patient type (medical, surgical), comorbidities (defined as those comorbidities reflected in the case history, with current or previous treatment for the chronic disorder involved), the SAPS (Simplified Acute Physiology Score) 3 as a measure of severity upon admission, stay in the ICU and in hospital, and in-ICU and in-hospital mortality.</p><p id="par0075" class="elsevierStylePara elsevierViewall">The operation of our ICU incorporates the “ICU without walls” model, which involves the proactive early detection of patients at risk in the hospital, with intervention of the intensivists outside the ICU.<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">11–13</span></a> Our secondary objective was to determine whether this model is able to influence the results obtained. With this in mind, we designed a <span class="elsevierStyleItalic">post hoc</span> analysis, differentiating between two subgroups within the off-hours patient group. The subgroups were distinguished on the basis of the “ICU without walls” activities, which only take place in subgroup 1, and not in subgroup 2. However, in both subgroups the general personnel working in the hospital was the same, and lower in number than in the on-hours group:<ul class="elsevierStyleList" id="lis0015"><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">1.</span><p id="par0080" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Subgroup 1</span>: patients admitted during the daily night shift</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">2.</span><p id="par0085" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Subgroup 2</span>: patients admitted on weekends and holidays</p></li></ul></p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Statistical analysis</span><p id="par0090" class="elsevierStylePara elsevierViewall">The data are reported as percentages or as the median and interquartile range. In the case of continuous variables we used the Kolmogorov–Smirnov test to determine the presence or absence of a normal distribution. Univariate analysis of continuous and categorical variables was made using the Mann–Whitney <span class="elsevierStyleItalic">U</span>-test and the chi-squared test, respectively. A stepwise multivariate logistic regression analysis was subsequently made, including all the variables evaluated in the univariate analysis. A cutoff point of 0.1 was used in the model, with <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.10 for exclusion from the model, and an alpha-error of 5%.</p><p id="par0095" class="elsevierStylePara elsevierViewall">In order to avoid possible statistical confounding factors, we performed a multivariate analysis including all the studied variables, stratifying according to the different work shifts (morning, afternoon and night) and holiday or daily shifts. In this regard, we followed the same stepwise multivariate logistic regression model, with exploration of the possible iterations.</p><p id="par0100" class="elsevierStylePara elsevierViewall">The study was approved by the local Ethics Committee, and patient informed consent was not required, in view of the non-interventional nature of the study and the retrospective analysis of the results.</p></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Results</span><p id="par0105" class="elsevierStylePara elsevierViewall">A total of 1405 patients were admitted to the ICU during the study period. Of these, 299 patients admitted on a scheduled basis due to high-risk surgery were excluded. A total of 504 patients were included in the on-hours group and 602 in the off-hours group (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall">No significant differences were observed in terms of patient age, gender or origin, patient type or mean stay in either the ICU or in hospital after discharge from the Unit. However, the patients in the off-hours group had a greater severity score as measured with the SAPS 3, and a greater presence of renal comorbidity. With regard to the distribution of the patients according to the disease process leading to admission, we recorded no significant differences between medical versus surgical patients, or in terms of the medical disorder on contrasting coronary disease versus other medical disorders (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.29). The mortality rate in the ICU was significantly higher in the off-hours group than in the on-hours group, and this difference persisted on analyzing in-hospital mortality. In both groups the in-hospital mortality rate was lower than expected from the predicted mortality rate calculated by the SAPS 3 (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0115" class="elsevierStylePara elsevierViewall">In the multivariate analysis referred to hospital mortality, the risk factors found to be independently associated to mortality were the SAPS 3 (OR 1.10; 95%CI 1.08–1.12; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.01) and belonging to the off-hours group (OR 2.00; 95%CI 1.20–3.33; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.01).</p><p id="par0120" class="elsevierStylePara elsevierViewall">The <span class="elsevierStyleItalic">post hoc</span> analysis of the off-hours subgroups yielded the following results:</p><p id="par0125" class="elsevierStylePara elsevierViewall">The patients included in subgroup 1 (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>257) and in subgroup 2 (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>345) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>) showed no differences in terms of age, gender, origin, patient type or SAPS 3. However, mortality in the ICU was higher in those admitted to subgroup 2 than in those admitted to subgroup 1. This same difference was observed on considering in-hospital mortality (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>). In the multivariate analysis, the variables found to be independently associated to in-hospital mortality were the SAPS 3 (OR 1.09; 95%CI 1.07–1.11; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.01) and belonging to subgroup 2 (OR 2.30; 95%CI 1.23–4.30; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.01).</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0130" class="elsevierStylePara elsevierViewall">On analyzing all the variables, the only two factors associated to in-hospital mortality were the SAPS 3 (OR 1.10; 95%CI 1.08–1.12) and admission on a holiday (OR 2.54; 95%CI 1.56–4.14). The full results of the multivariate analysis are reported in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>.</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0135" class="elsevierStylePara elsevierViewall">On the other hand, a significant difference was observed on analyzing the timing of admissions histogram, with a greater percentage of admissions during the daily morning shifts (scheduled surgery patients were excluded) versus a greater percentage of admissions during the night shift on weekends and holidays (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Discussion</span><p id="par0140" class="elsevierStylePara elsevierViewall">Although our study showed survival in both groups to be greater than predicted by the severity indicators employed, the patients who were admitted to the ICU in the course of the daily shifts showed a better prognosis than those admitted on weekends or holidays.</p><p id="par0145" class="elsevierStylePara elsevierViewall">Our results coincide with those of earlier studies that analyzed the timing of admission and the prognosis of patients admitted to the ICU. Bhonagiri et al.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">1</span></a> recorded a lower in-ICU mortality rate in the 6 p.m. to 5:59 a.m. interval than in the 6 a.m. to 5:59 p.m. period (9.1% versus 10.8%; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001), and Kuijsten et al.<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">2</span></a> observed a greater mortality risk on weekends than during the daily shifts. However, although Ju et al.<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">14</span></a> described a difference in mortality between the night shift and the day shift (OR 1.72; 95%CI 1.118–2.74), no such difference was recorded on comparing weekends versus daily shifts. Nwosu et al.<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">15</span></a> in turn reported a difference in mortality in patients admitted to the ICU on weekends versus daily shifts, though statistical significance was not reached. Laupland et al.<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">16</span></a> likewise recorded no differences regarding in-hospital mortality among patients admitted to the ICU at night or on Saturdays or Sundays versus the daily shifts of the working week. The metaanalysis conducted by Cavallazzi et al.<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">17</span></a> found an association referred to admission to the ICU on weekends, but not to admission at night.</p><p id="par0150" class="elsevierStylePara elsevierViewall">Differences in results are also found in other settings. Freemantle et al. observed greater in-hospital mortality when the patients were admitted to hospital on weekends than on the working week days<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">3</span></a> also in patients with acute coronary syndrome and ST-segment elevation,<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">18</span></a> patients undergoing elective surgery,<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">19</span></a> and patients admitted to the emergency room<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">20</span></a>–though no association could be demonstrated between the timing of admission and mortality as in the study published by Fonarow et al.<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">21</span></a> in patients admitted due to heart failure, or by Carr et al.<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">22</span></a> in trauma patients.</p><p id="par0155" class="elsevierStylePara elsevierViewall">A number of hypotheses have been proposed to explain these differences in mortality, based fundamentally on differences in the organization of the work shifts, with or without the presence of intensivists, or based on the experience of the intensivist on duty (resident in training versus staff physician), in units assisting seriously ill patients upon admission. A metaanalysis carried out by Wilcox et al.<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">5</span></a> showed a significant difference on comparing high intensity staffing, where the patient is moved to an ICU supervised by an intensivist, versus low intensity staffing, where no intensivist is present–with greater in-ICU survival in the high intensity staffing group (RR 0.81; 95%CI 0.68–0.96). However, on examining the 24-h intensivist model versus intensivist coverage only during the day shift, no decrease in mortality was found (RR 0.88; 95%CI 0.7–1.1). Another hypothesis is based on patient severity upon admission, which is greater in patients admitted at night, as in the study published by Ju et al.,<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">14</span></a> where a high APACHE II score (>8) versus a low APACHE II score (<8) was found to be an independent predictor of mortality (OR 1.113; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001).</p><p id="par0160" class="elsevierStylePara elsevierViewall">In our study, the patients admitted off-hours had greater severity upon admission as determined by the SAPS 3, with less medical personnel available for care (a single intensivist on duty). This is consistent with the abovementioned hypotheses.</p><p id="par0165" class="elsevierStylePara elsevierViewall">One element that distinguishes us from other units is our “ICU without walls” activity, based on the early detection of patients at risk in the hospital, outside the ICU, and which allows us to intervene before organ failure occurs. In a before-after study published by our group,<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">11</span></a> we demonstrated benefit in terms of clinical outcome among the intervened patients, with a better management of the available healthcare resources, and a decrease in mortality in the ICU among the patients admitted during the period in which the project was implemented (OR 0.42; 95%CI 0.18–0.98; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.04).</p><p id="par0170" class="elsevierStylePara elsevierViewall">For this reason, our secondary objective in this study was to determine whether an increased probability of a favorable prognosis could be due to the earlier identification of patient severity and earlier admission to the ICU. In order to identify a possible relationship between the “ICU without walls” activity and the outcomes, we compared the two subgroups within the off-hours group: subgroup 1 (daily night shifts) and subgroup 2 (weekends and holidays), where in both instances only the intensivist on duty is present–the sole difference between the two subgroups being the “ICU without walls” activity during the daily morning shifts but not on weekends or holidays. We found that for the same patient severity as evaluated by the SAPS 3, the in-ICU mortality rate was significantly higher in the patients belonging to subgroup 2. Likewise, the multivariate analysis showed the variables independently associated to in-hospital mortality to be the SAPS 3 and belonging to subgroup 2.</p><p id="par0175" class="elsevierStylePara elsevierViewall">These results support the idea that the early detection of potentially critical patients and their consequent improved survival rates<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">11,23–26</span></a> could (among other factors) influence the lesser mortality found in subgroup 1 versus subgroup 2, since there is no “ICU without walls” activity on weekends and holidays–the patients in the latter case being admitted later, and therefore with a poorer prognosis. This circumstance is reflected by the timing of admissions histogram, where a greater percentage of admissions in observed in the course of the daily morning shifts (scheduled surgery patients being excluded) versus a greater percentage of admissions during the night shifts on weekends and holidays (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><p id="par0180" class="elsevierStylePara elsevierViewall">The present study has the limitations inherent to its single-center nature. On the other hand, its non-interventional design does not allow us to confirm the hypothesis referred to our secondary objective. In this regard, we can only support the possibility of a relationship between the “ICU without walls” activity (among other factors) and lesser mortality in the analyzed subgroups. Likewise, we are unable to determine whether there is a real difference in the time between the detection of patient severity and admission to the ICU. However, our observations could support the hypothesis that extending the “ICU without walls” system to the weekends could result in improved patient outcomes.</p><p id="par0185" class="elsevierStylePara elsevierViewall">Another limitation has been the use of the SAPS 3 as a patient severity indicator upon admission to the ICU, since in patients with few failed organs the SAPS 3 overestimates predicted mortality–this possibly explaining the great difference between predicted and actual hospital mortality.<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">27</span></a></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Conclusions</span><p id="par0190" class="elsevierStylePara elsevierViewall">Admission to the off-hours group is independently associated to mortality. Admission on weekends is likewise independently associated to mortality, regardless of the daily shift involved.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Conflicts of interest</span><p id="par0195" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:3 [ "identificador" => "xres600893" "titulo" => "Abstract" "secciones" => array:8 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Design" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Scope" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Patients or participants" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Interventions" ] 5 => array:2 [ "identificador" => "abst0030" "titulo" => "Variables of interest" ] 6 => array:2 [ "identificador" => "abst0035" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec615081" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres600892" "titulo" => "Resumen" "secciones" => array:8 [ 0 => array:2 [ "identificador" => "abst0045" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0050" "titulo" => "Diseño" ] 2 => array:2 [ "identificador" => "abst0055" "titulo" => "Ámbito" ] 3 => array:2 [ "identificador" => "abst0060" "titulo" => "Pacientes o participantes" ] 4 => array:2 [ "identificador" => "abst0065" "titulo" => "Intervenciones" ] 5 => array:2 [ "identificador" => "abst0070" "titulo" => "Variables de interés" ] 6 => array:2 [ "identificador" => "abst0075" "titulo" => "Resultados" ] 7 => array:2 [ "identificador" => "abst0080" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec615082" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Material and methods" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Statistical analysis" ] ] ] 6 => array:2 [ "identificador" => "sec0020" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0025" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0030" "titulo" => "Conclusions" ] 9 => array:2 [ "identificador" => "sec0035" "titulo" => "Conflicts of interest" ] 10 => array:2 [ "identificador" => "xack202383" "titulo" => "Acknowledgement" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2014-08-25" "fechaAceptado" => "2014-11-24" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec615081" "palabras" => array:6 [ 0 => "Early diagnosis" 1 => "Decision support techniques" 2 => "Hospital rapid response team" 3 => "Outcome" 4 => "Critical care" 5 => "Time admission" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec615082" "palabras" => array:6 [ 0 => "Diagnóstico precoz" 1 => "Herramientas de decisión clínica" 2 => "Equipos de respuesta rápida" 3 => "Pronóstico" 4 => "Cuidados críticos" 5 => "Momento de ingreso" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To assess the repercussion of the timing of admission to the ICU upon patient prognosis.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Design</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A prospective, observational, non-interventional cohort study was carried out.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Scope</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A second level hospital with 210 operational beds and a general ICU with 8 operational beds.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Patients or participants</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The study comprised all patients admitted to the ICU during 3 years (January 2010 to December 2012), excluding those subjects admitted from the operating room after scheduled surgery. The patients were divided into 2 groups according to the timing of admission (on-hours or off-hours).</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Interventions</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Non-interventional study.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Variables of interest</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">An analysis was made of demographic variables (age, sex), origin (emergency room, hospital ward, operating room), comorbidities and SAPS 3 as severity score upon admission, length of stay in the ICU and hospital ward, and ICU and hospital mortality.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">A total of 504 patients were included in the on-hours group, versus 602 in the off-hours group. Multivariate analysis showed the factors independently associated to hospital mortality to be SAPS 3 (OR 1.10; 95%CI 1.08–1.12), and off-hours admission (OR 2.00; 95%CI 1.20–3.33). In a subgroup analysis of the off-hours group, the admission of patients on weekends or non-working days compared to daily night shifts was found to be independently associated to hospital mortality (OR 2.30; 95%CI 1.23–4.30).</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Admission to the ICU in off-hours is independently associated to patient mortality, which is also higher in patients admitted on weekends and non-working days compared to the daily night shifts.</p></span>" "secciones" => array:8 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Design" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Scope" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Patients or participants" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Interventions" ] 5 => array:2 [ "identificador" => "abst0030" "titulo" => "Variables of interest" ] 6 => array:2 [ "identificador" => "abst0035" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Objetivo</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Evaluar la repercusión del momento de ingreso en UCI sobre el pronóstico de los pacientes.</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Diseño</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Estudio de cohorte prospectivo, observacional y no intervencionista. Se consideró <span class="elsevierStyleItalic">on-hours</span> el turno de mañana y tarde de los días laborables y <span class="elsevierStyleItalic">off-hours</span> el resto de los turnos.</p></span> <span id="abst0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Ámbito</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Hospital de nivel 2 con 210 camas en funcionamiento y UCI polivalente con 8 camas.</p></span> <span id="abst0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Pacientes o participantes</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Todos los pacientes que ingresaron en la UCI durante 3 años, de enero de 2010 a diciembre de 2012, excluyendo aquellos pacientes procedentes de quirófano tras una cirugía programada. Los pacientes se estratificaron en 2 grupos en función de que el momento de ingreso fuera <span class="elsevierStyleItalic">on-hours</span> u <span class="elsevierStyleItalic">off-hours</span>.</p></span> <span id="abst0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Intervenciones</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Estudio no intervencionista.</p></span> <span id="abst0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Variables de interés</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Se analizaron las variables demográficas (edad, sexo), la procedencia (urgencias, planta de hospitalización, quirófano), el tipo de paciente (médico, quirúrgico), las comorbilidades y el SAPS 3 como puntuación de gravedad al ingreso, estancia en UCI y hospitalaria, además de mortalidad en la UCI y en el hospital.</p></span> <span id="abst0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Resultados</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron 504 pacientes en el grupo <span class="elsevierStyleItalic">on-hours</span> y 602 en el grupo <span class="elsevierStyleItalic">off-hours</span>. En el análisis multivariable los factores asociados de forma independiente con la mortalidad hospitalaria fueron SAPS 3 (OR 1,10; IC 95% 1,08-1,12) y grupo <span class="elsevierStyleItalic">off-hours</span> (OR 2,00; IC 95% 1,20-3,33). En un análisis de subgrupos del grupo <span class="elsevierStyleItalic">off-hours</span> el ingreso de los pacientes en fin de semana o festivo frente a las noches de los días de diario se asoció de forma independiente con la mortalidad hospitalaria (OR 2,30; IC 95% 1,23-4,30).</p></span> <span id="abst0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conclusiones</span><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Ingresar en el grupo <span class="elsevierStyleItalic">off-hours</span> se asocia de forma independiente con la mortalidad. El ingreso en festivo se asocia de forma independiente con la mortalidad, independientemente del turno en que se produzca el ingreso los días de diario.</p></span>" "secciones" => array:8 [ 0 => array:2 [ "identificador" => "abst0045" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0050" "titulo" => "Diseño" ] 2 => array:2 [ "identificador" => "abst0055" "titulo" => "Ámbito" ] 3 => array:2 [ "identificador" => "abst0060" "titulo" => "Pacientes o participantes" ] 4 => array:2 [ "identificador" => "abst0065" "titulo" => "Intervenciones" ] 5 => array:2 [ "identificador" => "abst0070" "titulo" => "Variables de interés" ] 6 => array:2 [ "identificador" => "abst0075" "titulo" => "Resultados" ] 7 => array:2 [ "identificador" => "abst0080" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Abella A, Hermosa C, Enciso V, Torrejón I, Molina R, Salinas I, et al. Efecto del momento de ingreso sobre el pronóstico de los pacientes en la Unidad de Cuidados Intensivos: <span class="elsevierStyleItalic">on-hours</span> vs. <span class="elsevierStyleItalic">off-hours</span>. Med Intensiva. 2016;40:26–32.</p>" ] ] "multimedia" => array:5 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 932 "Ancho" => 1464 "Tamanyo" => 76491 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Patient flow chart.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 756 "Ancho" => 1561 "Tamanyo" => 45470 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Histogram showing the distribution of patient admissions according to work shift (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.01).</p>" ] ] 2 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">IQ: interquartile; SAPS 3: Simplified Acute Physiology Score; ICU: Intensive Care Unit.</p>" "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"> \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">On-hours</span> (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>504) \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">Off-hours</span> (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>602) \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> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Age in years, median (IQ range)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">63 (50–76) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">62 (50–74) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.41 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Female gender %</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">37 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">37 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.94 \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="elsevierStyleItalic">Origin, %</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Emergency care \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">74 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">73 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.98 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Ward \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Operating room \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \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">Patient type, %</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Medical \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">86 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">84 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.33 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Surgical \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \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">Comorbidity, %</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Cardiovascular \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">48 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Respiratory \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">21 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.21 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Renal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.03 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">SAPS 3 (IQ range)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">49 (40–58) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">51 (41–63) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.003 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">SAPS 3 predicted mortality, %</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Stay in ICU, days (IQ range)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (2–5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (2–4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.91 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Stay in hospital, days (IQ range)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 (2–7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 (2–9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.89 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Mortality in ICU, n (%)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17 (3.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">53 (8.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.0002 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Mortality in hospital, n (%)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">28 (5.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">70 (11.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.0004 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab983098.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">Results of the on-hours group versus the off-hours group.</p>" ] ] 3 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0110" class="elsevierStyleSimplePara elsevierViewall">IQ: interquartile; SAPS 3: Simplified Acute Physiology Score; ICU: Intensive Care Unit.</p>" "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"> \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">Subgroup 1 (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>257) \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">Subgroup 2 (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>345) \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> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Age in years, median (IQ range)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">64 (52–76) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">61 (49–71) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.06 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Female gender, %</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">36 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">37 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.85 \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="elsevierStyleItalic">Origin, %</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Emergency care \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">74 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">73 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.75 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Ward \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>operating room \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \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">Patient type, %</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Medical \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">85 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">84 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.74 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Surgical \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \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">Comorbidity, %</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Cardiovascular \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">47 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">52 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.32 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Respiratory \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">23 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.07 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Renal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.99 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">SAPS 3 (IQ range)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">49 (41–62) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">53 (42–64) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.18 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Mortality in ICU, %</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.01 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Mortality in hospital, %</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.01 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab983099.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">Results of subgroup 1 (daily night shift) versus subgroup 2 (weekends and holidays).</p>" ] ] 4 => array:7 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0120" class="elsevierStyleSimplePara elsevierViewall">95%CI: 95% confidence interval; SAPS 3: Simplified Acute Physiology Score.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variable \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Odds ratio (95%CI) \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> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.01 (0.99–1.02) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.48 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Gender \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.76 (0.47–1.23) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.27 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Origin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.00 (0.64–1.57) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.00 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Patient type \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.95 (0.51–1.77) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.87 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">SAPS 3 score \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.10 (1.08–1.12) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.005 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cardiovascular comorbidity \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.06 (0.64–1.76) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.81 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Respiratory comorbidity \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.89 (0.52–1.53) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.67 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Renal comorbidity \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.70 (0.34–1.44) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.33 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Endocrine comorbidity \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.77 (0.45–1.34) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.36 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Admission shift \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.90 (0.55–1.46) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.66 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Admission on holiday \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.54 (1.56–4.14) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.0002 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab983097.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0115" class="elsevierStyleSimplePara elsevierViewall">Results of the multivariate analysis.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:27 [ 0 => array:3 [ "identificador" => "bib0140" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Increased mortality associated with after-hours and weekend admission to the intensive care unit: a retrospective analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "D. Bhonagiri" 1 => "D.V. Pilcher" 2 => "M.J. Bailey" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Med J Aust" "fecha" => "2011" "volumen" => "194" "paginaInicial" => "287" "paginaFinal" => "292" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21426282" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0145" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hospital mortality is associated with ICU admission time" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "H.A. Kuijsten" 1 => "S. Brinkman" 2 => "I.A. Meynaar" 3 => "P.E. Spronk" 4 => "J.I. van der Spoel" 5 => "R.J. Bosman" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00134-010-1918-1" "Revista" => array:6 [ "tituloSerie" => "Intensive Care Med" "fecha" => "2010" "volumen" => "36" "paginaInicial" => "1765" "paginaFinal" => "1771" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20549184" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0150" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Weekend hospitalization and additional risk of death: an analysis of inpatient data" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "N. Freemantle" 1 => "M. Richardson" 2 => "J. Wood" 3 => "D. Ray" 4 => "S. Khosla" 5 => "D. Shahian" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1258/jrsm.2012.120009" "Revista" => array:6 [ "tituloSerie" => "J R Soc Med" "fecha" => "2012" "volumen" => "105" "paginaInicial" => "74" "paginaFinal" => "84" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22307037" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0155" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Weekend admissions to critical care: why do more of these patients die?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J.G. Alspach" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4037/ccn2010750" "Revista" => array:6 [ "tituloSerie" => "Crit Care Nurse" "fecha" => "2010" "volumen" => "30" "paginaInicial" => "10" "paginaFinal" => "12" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21123227" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0160" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Do intensivist staffing patterns influence hospital mortality following ICU admission? A systematic review and meta-analyses" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.E. Wilcox" 1 => "C.A. Chong" 2 => "D.J. Niven" 3 => "G.D. Rubenfeld" 4 => "K.M. Rowan" 5 => "H. Wunsch" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/CCM.0b013e318292313a" "Revista" => array:6 [ "tituloSerie" => "Crit Care Med" "fecha" => "2013" "volumen" => "41" "paginaInicial" => "2253" "paginaFinal" => "2274" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23921275" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0165" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Continuity of care in intensive care units: a cluster-randomized trial of intensivist staffing" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "Midwest Critical Care Consortium" "etal" => true "autores" => array:6 [ 0 => "N.A. Ali" 1 => "J. Hammersley" 2 => "S.P. Hoffmann" 3 => "J.M. O’Brien Jr." 4 => "G.S. Phillips" 5 => "M. Rashkin" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1164/rccm.201103-0555OC" "Revista" => array:6 [ "tituloSerie" => "Am J Respir Crit Care Med" "fecha" => "2011" "volumen" => "184" "paginaInicial" => "803" "paginaFinal" => "808" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21719756" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0170" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Off hour admission to an intensivist-led ICU is not associated with increased mortality" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "I.A. Meynaar" 1 => "J.I. van der Spoel" 2 => "J.H. Rommes" 3 => "M. van Spreuwel-Verheijen" 4 => "R.J. Bosman" 5 => "P.E. Spronk" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/cc7904" "Revista" => array:5 [ "tituloSerie" => "Crit Care" "fecha" => "2009" "volumen" => "13" "paginaInicial" => "R84" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19500333" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0175" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Impact of intensive care unit admission during morning bedside rounds and mortality: a multi-center retrospective cohort study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "I.A. De Souza" 1 => "C.J. Karvellas" 2 => "R.N. Gibney" 3 => "S.M. Bagshaw" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/cc11329" "Revista" => array:5 [ "tituloSerie" => "Crit Care" "fecha" => "2012" "volumen" => "16" "paginaInicial" => "R72" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22554100" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0180" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Association between ICU admission during morning rounds and mortality" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "B. Afessa" 1 => "O. Gajic" 2 => "I.J. Morales" 3 => "M.T. Keegan" 4 => "S.G. Peters" 5 => "R.D. Hubmayr" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1378/chest.09-0529" "Revista" => array:6 [ "tituloSerie" => "Chest" "fecha" => "2009" "volumen" => "136" "paginaInicial" => "1489" "paginaFinal" => "1495" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19505985" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0185" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Does admission during morning rounds increase the mortality of patients in the medical ICU?" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Bisbal" 1 => "V. Pauly" 2 => "M. Gainnier" 3 => "J.M. Forel" 4 => "A. Roch" 5 => "C. Guervilly" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1378/chest.11-2680" "Revista" => array:6 [ "tituloSerie" => "Chest" "fecha" => "2012" "volumen" => "142" "paginaInicial" => "1179" "paginaFinal" => "1184" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22556321" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0190" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "ICU without walls project. Effect of the early detection of patients at risk" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Abella Álvarez" 1 => "I. Torrejón Pérez" 2 => "V. Enciso Calderón" 3 => "C. Hermosa Gelbard" 4 => "J.J. Sicilia Urban" 5 => "M. Ruiz Grinspan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.medin.2012.08.006" "Revista" => array:6 [ "tituloSerie" => "Med Intensiva" "fecha" => "2013" "volumen" => "37" "paginaInicial" => "12" "paginaFinal" => "18" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23059055" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0195" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Intensive Care Unit without walls: seeking patient safety by improving the efficiency of the system" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "F. Gordo" 1 => "A. Abella" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Med Intensiva" "fecha" => "2014" "volumen" => "38" "paginaInicial" => "438" "paginaFinal" => "443" ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0200" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Introduction of a management system in intensive care medicine based on the safety of the seriously ill patient during the entire hospitalization process: extended intensive care medicine" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "E. Calvo Herranz" 1 => "M.T. Mozo Martín" 2 => "F. Gordo Vidal" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.medin.2011.05.008" "Revista" => array:6 [ "tituloSerie" => "Med Intensiva" "fecha" => "2011" "volumen" => "35" "paginaInicial" => "354" "paginaFinal" => "360" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21722991" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0205" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effect of admission time on mortality in an intensive care unit in Mainland China: a propensity score matching analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.J. Ju" 1 => "G.W. Tu" 2 => "Y. Han" 3 => "H.Y. He" 4 => "Y.Z. He" 5 => "H.L. Mao" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Crit Care" "fecha" => "2013" "volumen" => "17" "paginaInicial" => "R230" ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0210" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Weekend versus weekday hospital deaths: analysis of in-patient data in a Nigerian tertiary healthcare center" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "B.O. Nwosu" 1 => "N.O. Eke" 2 => "A. Obi-Nwosu" 3 => "O.J. Osakwe" 4 => "C.O. Eke" 5 => "N.P. Obi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4103/1119-3077.116900" "Revista" => array:6 [ "tituloSerie" => "Niger J Clin Pract" "fecha" => "2013" "volumen" => "16" "paginaInicial" => "501" "paginaFinal" => "504" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23974747" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0215" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mortality associated with timing of admission to and discharge from ICU: a retrospective cohort study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "K.B. Laupland" 1 => "B. Misset" 2 => "B. Souweine" 3 => "A. Tabah" 4 => "E. Azoulay" 5 => "D. Goldgran-Toledano" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/1472-6963-11-321" "Revista" => array:5 [ "tituloSerie" => "BMC Health Serv Res" "fecha" => "2011" "volumen" => "11" "paginaInicial" => "321" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22115194" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0220" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Association between time of admission to the ICU and mortality: a systematic review and metaanalysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "R. Cavallazzi" 1 => "P.E. Marik" 2 => "A. Hirani" 3 => "M. Pachinburavan" 4 => "T.S. Vasu" 5 => "B.E. Leiby" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1378/chest.09-3018" "Revista" => array:6 [ "tituloSerie" => "Chest" "fecha" => "2010" "volumen" => "138" "paginaInicial" => "68" "paginaFinal" => "75" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20418364" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0225" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Off-hour presentation and outcomes in patients with acute myocardial infarction: systematic review and meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Sorita" 1 => "A. Ahmed" 2 => "S.R. Starr" 3 => "K.M. Thompson" 4 => "D.A. Reed" 5 => "L. Prokop" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "BMJ" "fecha" => "2014" "volumen" => "348" "paginaInicial" => "f7393" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24452368" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0230" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Day of week of procedure and 30 day mortality for elective surgery: retrospective analysis of hospital episode statistics" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "P. Aylin" 1 => "R. Alexandrescu" 2 => "M.H. Jen" 3 => "E.K. Mayer" 4 => "A. Bottle" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "BMJ" "fecha" => "2013" "volumen" => "346" "paginaInicial" => "f2424" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23716356" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0235" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Weekend admission as an independent predictor of mortality: an analysis of Scottish hospital admissions" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "A.E. Handel" 1 => "S.V. Patel" 2 => "A. Skingsley" 3 => "K. Bramley" 4 => "R. Sobieski" 5 => "S.V. Ramagopalan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/bmjopen-2012-001789" "Revista" => array:5 [ "tituloSerie" => "BMJ Open" "fecha" => "2012" "volumen" => "2" "paginaInicial" => "e001789" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23135542" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0240" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Day of admission and clinical outcomes for patients hospitalized for heart failure: findings from the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients With Heart Failure (OPTIMIZE-HF)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G.C. Fonarow" 1 => "W.T. Abraham" 2 => "N.M. Albert" 3 => "W.G. Stough" 4 => "M. Gheorghiade" 5 => "B.H. Greenberg" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/CIRCHEARTFAILURE.107.748376" "Revista" => array:6 [ "tituloSerie" => "Circ Heart Fail" "fecha" => "2008" "volumen" => "1" "paginaInicial" => "50" "paginaFinal" => "57" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19808270" "web" => "Medline" ] ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0245" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Weekend and night outcomes in a statewide trauma system" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "B.G. Carr" 1 => "P.M. Reilly" 2 => "C.W. Schwab" 3 => "C.C. Branas" 4 => "J. Geiger" 5 => "D.J. Wiebe" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/archsurg.2011.60" "Revista" => array:6 [ "tituloSerie" => "Arch Surg" "fecha" => "2011" "volumen" => "146" "paginaInicial" => "810" "paginaFinal" => "817" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21422328" "web" => "Medline" ] ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0250" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Multicenter development and validation of a risk stratification tool for ward patients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.M. Churpek" 1 => "T.C. Yuen" 2 => "C. Winslow" 3 => "A.A. Robicsek" 4 => "D.O. Meltzer" 5 => "R.D. Gibbons" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Am J Respir Crit Care Med" "fecha" => "2014" "volumen" => "190" "paginaInicial" => "649" "paginaFinal" => "655" ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0255" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "SECI (Servicio Extendido de Cuidados Intensivos): mirando fuera de la UCI" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M.S. Holanda Peña" 1 => "M.J. Domínguez Artiga" 2 => "E. Ots Ruiz" 3 => "M.I. Lorda de los Ríos" 4 => "A. Castellanos Ortega" 5 => "F. Ortiz Melón" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.medin.2011.03.012" "Revista" => array:6 [ "tituloSerie" => "Med Intensiva" "fecha" => "2011" "volumen" => "35" "paginaInicial" => "349" "paginaFinal" => "353" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21571395" "web" => "Medline" ] ] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0260" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Aplicación de las técnicas de información y comunicación (TICS) para la detección de pacientes de alto riesgo: alarmas de rápida asistencia. Estudio piloto del proyecto ARA-SON LLATZER" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "L. Socías Crespí" 1 => "G. Heras La Calle" 2 => "V.M. Estrada Rodríguez" 3 => "A. García Sánchez" 4 => "P. Ibáñez-Lucía" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.medin.2012.04.001" "Revista" => array:6 [ "tituloSerie" => "Med Intensiva" "fecha" => "2013" "volumen" => "37" "paginaInicial" => "19" "paginaFinal" => "26" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22683046" "web" => "Medline" ] ] ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0265" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Impacto de un nuevo modelo de Medicina Intensiva sobre la asistencia en un servicio de Medicina Intensiva" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. González-Castro" 1 => "F. Ortiz-Melon" 2 => "B. Suberviola" 3 => "M.S. Holanda" 4 => "M.J. Dominguez" 5 => "C. Blanco-Huelga" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.medin.2012.06.003" "Revista" => array:6 [ "tituloSerie" => "Med Intensiva" "fecha" => "2013" "volumen" => "37" "paginaInicial" => "27" "paginaFinal" => "32" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22959859" "web" => "Medline" ] ] ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0270" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "External validation of the Simplified Acute Physiology Score (SAPS) 3 in Spain" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C. López-Caler" 1 => "M. García-Delgado" 2 => "J. Carpio-Sanz" 3 => "J. Alvarez-Rodríguez" 4 => "E. Aguilar-Alonso" 5 => "E. Castillo-Lorente" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.medin.2013.06.003" "Revista" => array:6 [ "tituloSerie" => "Med Intensiva" "fecha" => "2014" "volumen" => "38" "paginaInicial" => "288" "paginaFinal" => "296" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24053903" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack202383" "titulo" => "Acknowledgement" "texto" => "<p id="par0200" class="elsevierStylePara elsevierViewall">Thanks are due to Dr. Alvaro Castellanos for his help in preparing the manuscript.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/21735727/0000004000000001/v1_201601310056/S2173572715000764/v1_201601310056/en/main.assets" "Apartado" => null "PDF" => "https://static.elsevier.es/multimedia/21735727/0000004000000001/v1_201601310056/S2173572715000764/v1_201601310056/en/main.pdf?idApp=WMIE&text.app=https://medintensiva.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572715000764?idApp=WMIE" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 7 | 10 | 17 |
| 2024 October | 43 | 38 | 81 |
| 2024 September | 44 | 25 | 69 |
| 2024 August | 61 | 32 | 93 |
| 2024 July | 80 | 28 | 108 |
| 2024 June | 63 | 45 | 108 |
| 2024 May | 57 | 31 | 88 |
| 2024 April | 56 | 43 | 99 |
| 2024 March | 50 | 21 | 71 |
| 2024 February | 47 | 38 | 85 |
| 2024 January | 44 | 37 | 81 |
| 2023 December | 44 | 42 | 86 |
| 2023 November | 67 | 30 | 97 |
| 2023 October | 36 | 32 | 68 |
| 2023 September | 41 | 37 | 78 |
| 2023 August | 33 | 23 | 56 |
| 2023 July | 39 | 26 | 65 |
| 2023 June | 28 | 27 | 55 |
| 2023 May | 47 | 28 | 75 |
| 2023 April | 50 | 22 | 72 |
| 2023 March | 73 | 34 | 107 |
| 2023 February | 65 | 29 | 94 |
| 2023 January | 47 | 22 | 69 |
| 2022 December | 58 | 28 | 86 |
| 2022 November | 69 | 35 | 104 |
| 2022 October | 51 | 29 | 80 |
| 2022 September | 40 | 27 | 67 |
| 2022 August | 44 | 43 | 87 |
| 2022 July | 28 | 33 | 61 |
| 2022 June | 37 | 23 | 60 |
| 2022 May | 45 | 33 | 78 |
| 2022 April | 39 | 28 | 67 |
| 2022 March | 52 | 58 | 110 |
| 2022 February | 47 | 33 | 80 |
| 2022 January | 45 | 46 | 91 |
| 2021 December | 56 | 33 | 89 |
| 2021 November | 47 | 37 | 84 |
| 2021 October | 80 | 70 | 150 |
| 2021 September | 53 | 23 | 76 |
| 2021 August | 38 | 21 | 59 |
| 2021 July | 30 | 36 | 66 |
| 2021 June | 60 | 20 | 80 |
| 2021 May | 52 | 47 | 99 |
| 2021 April | 115 | 53 | 168 |
| 2021 March | 80 | 22 | 102 |
| 2021 February | 74 | 32 | 106 |
| 2021 January | 67 | 20 | 87 |
| 2020 December | 38 | 13 | 51 |
| 2020 November | 33 | 19 | 52 |
| 2020 October | 39 | 30 | 69 |
| 2020 September | 29 | 18 | 47 |
| 2020 August | 22 | 21 | 43 |
| 2020 July | 35 | 24 | 59 |
| 2020 June | 57 | 20 | 77 |
| 2020 May | 49 | 9 | 58 |
| 2020 April | 65 | 21 | 86 |
| 2020 March | 28 | 9 | 37 |
| 2020 February | 92 | 31 | 123 |
| 2020 January | 38 | 26 | 64 |
| 2019 December | 36 | 20 | 56 |
| 2019 November | 49 | 34 | 83 |
| 2019 October | 62 | 23 | 85 |
| 2019 September | 35 | 19 | 54 |
| 2019 August | 41 | 14 | 55 |
| 2019 July | 36 | 24 | 60 |
| 2019 June | 29 | 16 | 45 |
| 2019 May | 57 | 26 | 83 |
| 2019 April | 13 | 19 | 32 |
| 2019 March | 18 | 23 | 41 |
| 2019 February | 31 | 20 | 51 |
| 2019 January | 24 | 27 | 51 |
| 2018 December | 94 | 34 | 128 |
| 2018 November | 136 | 56 | 192 |
| 2018 October | 49 | 19 | 68 |
| 2018 September | 15 | 6 | 21 |
| 2018 August | 21 | 7 | 28 |
| 2018 July | 21 | 10 | 31 |
| 2018 June | 39 | 13 | 52 |
| 2018 May | 19 | 5 | 24 |
| 2018 April | 28 | 10 | 38 |
| 2018 March | 24 | 7 | 31 |
| 2018 February | 36 | 9 | 45 |
| 2018 January | 34 | 9 | 43 |
| 2017 December | 24 | 5 | 29 |
| 2017 November | 26 | 14 | 40 |
| 2017 October | 29 | 10 | 39 |
| 2017 September | 18 | 8 | 26 |
| 2017 August | 14 | 7 | 21 |
| 2017 July | 17 | 8 | 25 |
| 2017 June | 31 | 16 | 47 |
| 2017 May | 29 | 10 | 39 |
| 2017 April | 24 | 8 | 32 |
| 2017 March | 5 | 7 | 12 |
| 2017 February | 10 | 10 | 20 |
| 2017 January | 8 | 2 | 10 |
| 2016 December | 28 | 12 | 40 |
| 2016 November | 32 | 19 | 51 |
| 2016 October | 46 | 23 | 69 |
| 2016 September | 38 | 8 | 46 |
| 2016 August | 32 | 5 | 37 |
| 2016 July | 19 | 8 | 27 |
| 2016 June | 1 | 0 | 1 |
Show all
