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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">In 2015&#44; a new paediatric Acute Respiratory Distress Syndrome &#40;PARDS&#41; definition was published by the Paediatric Acute Lung Injury Consensus Conference &#40;PALICC&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> Contrary to the previous conferences &#40;AECC Barcelona 1994&#44; Berlin 2012&#41;&#44;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2&#44;3</span></a> in this new definition the findings of bilateral infiltrates in the chest imaging is not required&#44; with the appearance of unilateral infiltrates being sufficient&#46; PALICC investigators considered this a point of recommendation because of the lack of evidence of a different outcome in PARDS patients&#46; We report here two patients who have been diagnosed with PARDS using the new definition&#44; but whose outcome did not correspond with the evolution normally expected in patients with this clinical entity&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">From November 2011 to December 2015 71 infants from 0 to 12 months old with acute respiratory failure &#40;ARF&#41; required interhospital ground transport with continuous positive airway pressure &#40;CPAP&#41; to the Paediatric Intensive Care Units &#40;PICU&#41; of two tertiary-care hospitals&#46; Infants with neonatal pathologies were excluded&#46; The details of this retrospective cohort of patients have been published elsewere&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> In summary&#44; the causes for ARF were&#58; bronchiolitis &#40;76&#46;1&#37;&#41;&#44; wheezing episode &#40;19&#46;7&#37;&#41; and pneumonia &#40;4&#46;2&#37;&#41;&#46; No patients required change in the respiratory support or endotracheal intubation during interhospital transport&#46; The maximum respiratory support at PICU were&#58; 1&#46;4&#37; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41; high flow nasal cannula&#44; 54&#46;9&#37; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>39&#41; CPAP&#44; 36&#46;6&#37; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>26&#41; bilevel positive airway pressure and 5&#46;1&#37; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#41; invasive mechanical ventilation&#46; None of the patients died&#46; Because patients with transcutaneous oxygen saturation values higher than 97&#37; were excluded&#44;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> the ratio saturation measured via pulse oximetry to fraction of inspired oxygen &#40;S&#47;F ratio&#41; in the referral hospital was calculated in 74&#46;6&#37; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>53&#41; of patients&#44; while in the PICU it was calculated in 39&#46;4&#37; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>28&#41; of the cases&#46; The mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD S&#47;F before transfer was 322&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>109&#46;3 and upon arrival at PICU 300&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>93&#46;8 &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;033&#41;&#44; decreasing a median of 59 points during transfer&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The S&#47;F ratio prior to transfer was &#8804;150 in 4 infants &#40;128&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>27&#46;6&#41;&#44; who were diagnosed with bronchiolitis&#46; Chest radiography was performed in only two of these patients and in both the presence of unilateral infiltrates was seen&#46; Their S&#47;F prior to transfer was 136&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>18&#46;6&#46; Both infants were transferred with Helmet interface and Boussignac&#174; CPAP &#40;Vygon&#44; Ecouen&#44; France&#41;&#46; They both received CPAP as respiratory support in PICU&#46; These patients did not present cyanotic heart disease or chronic lung disease&#46; Using Kaplan&#8211;Meier analysis&#44; no differences were found in duration of total &#40;i&#46;e&#46; invasive and non-invasive&#41; ventilation between these two patients and the rest of the population&#58; 3 &#91;95&#37; CI&#58; 3&#8211;-&#93; days for patients with S&#47;F &#8804;150 and unilateral infiltrates vs&#46; 2 &#91;95&#37; CI&#58; 1&#46;3&#8211;5&#93; for the rest &#40;Log Rank test&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;930&#41;&#46; The median length of stay in PICU was 3&#46;5 &#91;95&#37; CI&#58; 3&#46;5&#8211;-&#93; days for patients with S&#47;F &#8804;150 and unilateral infiltrates vs&#46; 4 &#91;95&#37; CI&#58; 3&#8211;7&#93; for the rest &#40;Log Rank test&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;259&#41;&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">A good correlation between the partial pressure of oxygen&#47;fraction of inspired oxygen ratio and the S&#47;F has been demonstrated&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> A ratio S&#47;F &#8804;150 is required for the diagnosis of severe ARDS&#44; and it is independently associated with the need for endotracheal intubation&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> Invasive ventilation was not initiated in patients with S&#47;F ratio before transfer &#8804;150 and unilateral infiltrate because they did not meet ARDS criteria according to the current definitions at that time&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2&#44;3</span></a> In agreement with the new PALICC criteria&#44; the referred patients fulfilled the PARDS definition&#46; Invasive ventilation might have been considered as mandatory respiratory support during transport and in PICU&#46; However&#44; these patients presented a favourable evolution&#44; without the need for endotracheal intubation or a longer duration of ventilatory support or PICU length of stay&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Using autopsy findings as the gold standard&#44; AECC Barcelona definition showed good diagnostic accuracy &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; In adults&#44; the Turig-Good weight of evidence &#40;WOE&#41; was 6&#46;71 decibans &#40;dB&#41; for a positive result&#44; and for a negative result WOE was &#8722;5&#46;26<span class="elsevierStyleHsp" style=""></span>dB<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a>&#59; and in children&#44; the WOE for a positive was 7&#46;52<span class="elsevierStyleHsp" style=""></span>dB and for a negative was &#8722;6&#46;47<span class="elsevierStyleHsp" style=""></span>dB&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> In order to gain clinical usefulness&#44; the Berlin definition lost accuracy in confirming ARDS diagnosis &#40;for a positive the WOE was only 1&#46;52<span class="elsevierStyleHsp" style=""></span>dB&#41;&#44; but retained accuracy in discarding what is NOT an ARDS&#58; WOE for a negative was &#8722;11&#46;90<span class="elsevierStyleHsp" style=""></span>dB &#40;95&#37; CI<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;15&#46;56 to &#8722;6&#46;37&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a></p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">Because of this clinical observation&#44; in our opinion the PALICC definition is susceptible to producing false positive rates&#44; so the finding of bilateral infiltrates should be reconsidered as an essential tool for the diagnosis of PARDS&#46; If we follow the new paediatric recommendations&#44; only unilateral pulmonary infiltrates on chest radiograph&#44; we will lose the base of our best knowledge&#58; how to know&#44; accurately and confidently&#44; which hypoxaemic respiratory failure is NOT an ARDS&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> We consider the finding of unilateral infiltrates a point of controversy that requires further validation in prospective cohort studies&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0035" class="elsevierStylePara elsevierViewall">This research did not receive any specific grant from funding agencies in the public commercial&#44; or not-for-profit sectors&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflict of interest</span><p id="par0040" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interest&#46;</p></span></span>"
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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-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Accuracy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="4" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">AECC Barcelona 1994</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Berlin 2013</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">For adults<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a></th><th class="td" title="\n
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                  \t\t\t\t  " colspan="2" align="center" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">For children<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a></th><th class="td" title="\n
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                  \t\t\t\t  " colspan="2" align="center" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">For adults<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a></th></tr><tr title="table-row"><th class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">95&#37; CI&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">95&#37; CI&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">95&#37; CI&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">For a positive</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>LR&#43;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">4&#46;69&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">3&#46;14&#8211;6&#46;83&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">5&#46;64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">1&#46;03&#8211;18&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">1&#46;42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#46;27&#8211;1&#46;55&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>WOE&#43; &#40;decibans&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">6&#46;71&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">4&#46;97&#8211;8&#46;35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">7&#46;52&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;15&#8211;12&#46;65&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;52&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;04&#8211;1&#46;90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="7" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">For a negative</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>LR&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#46;30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#46;20&#8211;0&#46;43&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#46;23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;08&#8211;0&#46;95&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#46;06&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;03&#8211;0&#46;23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>WOE&#8722; &#40;decibans&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;5&#46;26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;6&#46;89 to &#8722;3&#46;66&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;6&#46;47&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;10&#46;75 to &#8722;0&#46;21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">&#8722;11&#46;90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;15&#46;56 to &#8722;6&#46;37&nbsp;\t\t\t\t\t\t\n
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Diagnostic accuracy of AECC 1994 and Berlin 2013 definitions&#44; using autopsy findings as the Gold Standard&#46; Build using Bayesian beta-binomial model with a non-informative Beta &#40;1&#47;2&#44; 1&#47;2&#41; prior distribution and data from references <a class="elsevierStyleCrossRef" href="#bib0085">&#91;7&#93;</a>&#44; <a class="elsevierStyleCrossRef" href="#bib0090">&#91;8&#93;</a> and <a class="elsevierStyleCrossRef" href="#bib0095">&#91;9&#93;</a>&#46;</p>"
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        0 => array:2 [
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              "identificador" => "bib0055"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pediatric acute respiratory distress syndrome&#58; consensus recommendations from the Pediatric Acute Lung Injury Consensus Conference"
                      "autores" => array:1 [
                        0 => array:2 [
                          "colaboracion" => "Pediatric Acute Lung Injury Consensus Conference Group"
                          "etal" => false
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                    0 => array:2 [
                      "doi" => "10.1097/PCC.0000000000000350"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatr Crit Care Med"
                        "fecha" => "2015"
                        "volumen" => "16"
                        "paginaInicial" => "428"
                        "paginaFinal" => "439"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25647235"
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              "identificador" => "bib0060"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Report of the American-European Consensus conference on acute respiratory distress syndrome&#58; definitions&#44; mechanisms&#44; relevant outcomes&#44; and clinical trial coordination&#46; Consensus Committee"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "G&#46;R&#46; Bernard"
                            1 => "A&#46; Artigas"
                            2 => "K&#46;L&#46; Brigham"
                            3 => "J&#46; Carlet"
                            4 => "K&#46; Falke"
                            5 => "L&#46; Hudson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/0883-9441(94)90033-7"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Crit Care"
                        "fecha" => "1994"
                        "volumen" => "9"
                        "paginaInicial" => "72"
                        "paginaFinal" => "81"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8199655"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0065"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Acute respiratory distress syndrome&#58; the Berlin definition"
                      "autores" => array:1 [
                        0 => array:2 [
                          "colaboracion" => "The ARDS Definition Task Force"
                          "etal" => false
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1001/jama.2012.5669"
                      "Revista" => array:6 [
                        "tituloSerie" => "JAMA"
                        "fecha" => "2012"
                        "volumen" => "307"
                        "paginaInicial" => "2526"
                        "paginaFinal" => "2533"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22797452"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "CPAP vs&#46; oxygen therapy in infants being transported due to acute respiratory failure"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "R&#46; Manso"
                            1 => "P&#46; Del Villar"
                            2 => "A&#46; Medina"
                            3 => "V&#46; Modesto"
                            4 => "C&#46; Molinos"
                            5 => "M&#46; Bartolom&#233;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:2 [
                        "tituloSerie" => "An Pediatr &#40;Barc&#41;"
                        "fecha" => "2019"
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                    ]
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                ]
              ]
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              "identificador" => "bib0075"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Comparison of SpO<span class="elsevierStyleInf">2</span> to PaO<span class="elsevierStyleInf">2</span> based markers of lung disease severity for children with acute lung injury"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "R&#46;G&#46; Khemani"
                            1 => "N&#46;J&#46; Thomas"
                            2 => "V&#46; Venkatachalam"
                            3 => "J&#46;P&#46; Scimeme"
                            4 => "T&#46; Berutti"
                            5 => "J&#46;B&#46; Schneider"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Crit Care Med &#91;Internet&#93;"
                        "fecha" => "2012"
                        "volumen" => "40"
                        "paginaInicial" => "1309"
                        "paginaFinal" => "1316"
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              "identificador" => "bib0080"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A multiple-center survey on the use in clinical practice of noninvasive ventilation as a first-line intervention for acute respiratory distress syndrome"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Antonelli"
                            1 => "G&#46; Conti"
                            2 => "A&#46; Esquinas"
                            3 => "L&#46; Montini"
                            4 => "S&#46;M&#46; Maggiore"
                            5 => "G&#46; Bello"
                          ]
                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/01.CCM.0000251821.44259.F3"
                      "Revista" => array:6 [
                        "tituloSerie" => "Crit Care Med"
                        "fecha" => "2007"
                        "volumen" => "35"
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Scientific Letter
New paediatric definition of acute respiratory distress syndrome: Only unilateral infiltrates. Are we sure about this?
Nueva definición pediátrica del síndrome de distrés respiratorio agudo: solo infiltrados unilaterales ¿Estamos seguros?
R. Manso Ruiz de la Cuestaa,
Corresponding author
raquelmansoruiz@gmail.com

Corresponding author.
, V. Modesto Alaportb, A. Medina Villanuevac, P. del Villar Guerrad, C. Molinos Norniellae, M. Bartolomé Canof
a Neonatal and Paediatric Intensive Care Unit, Complejo Hospitalario de Navarra, Spain
b Paediatric Intensive Care Unit, Hospital Universitari I Politècnic La Fe de Valencia, Valencia, Spain
c Paediatric Intensive Care Unit, Hospital Central de Asturias, Oviedo, Spain
d Department of Paediatrics, Complejo Asistencial de Segovia, Segovia, Spain
e Department of Paediatrics, Hospital Universitario de Cabueñes, Gijón, Spain
f Department of Paediatrics, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">In 2015&#44; a new paediatric Acute Respiratory Distress Syndrome &#40;PARDS&#41; definition was published by the Paediatric Acute Lung Injury Consensus Conference &#40;PALICC&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> Contrary to the previous conferences &#40;AECC Barcelona 1994&#44; Berlin 2012&#41;&#44;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2&#44;3</span></a> in this new definition the findings of bilateral infiltrates in the chest imaging is not required&#44; with the appearance of unilateral infiltrates being sufficient&#46; PALICC investigators considered this a point of recommendation because of the lack of evidence of a different outcome in PARDS patients&#46; We report here two patients who have been diagnosed with PARDS using the new definition&#44; but whose outcome did not correspond with the evolution normally expected in patients with this clinical entity&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">From November 2011 to December 2015 71 infants from 0 to 12 months old with acute respiratory failure &#40;ARF&#41; required interhospital ground transport with continuous positive airway pressure &#40;CPAP&#41; to the Paediatric Intensive Care Units &#40;PICU&#41; of two tertiary-care hospitals&#46; Infants with neonatal pathologies were excluded&#46; The details of this retrospective cohort of patients have been published elsewere&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> In summary&#44; the causes for ARF were&#58; bronchiolitis &#40;76&#46;1&#37;&#41;&#44; wheezing episode &#40;19&#46;7&#37;&#41; and pneumonia &#40;4&#46;2&#37;&#41;&#46; No patients required change in the respiratory support or endotracheal intubation during interhospital transport&#46; The maximum respiratory support at PICU were&#58; 1&#46;4&#37; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41; high flow nasal cannula&#44; 54&#46;9&#37; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>39&#41; CPAP&#44; 36&#46;6&#37; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>26&#41; bilevel positive airway pressure and 5&#46;1&#37; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#41; invasive mechanical ventilation&#46; None of the patients died&#46; Because patients with transcutaneous oxygen saturation values higher than 97&#37; were excluded&#44;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> the ratio saturation measured via pulse oximetry to fraction of inspired oxygen &#40;S&#47;F ratio&#41; in the referral hospital was calculated in 74&#46;6&#37; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>53&#41; of patients&#44; while in the PICU it was calculated in 39&#46;4&#37; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>28&#41; of the cases&#46; The mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD S&#47;F before transfer was 322&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>109&#46;3 and upon arrival at PICU 300&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>93&#46;8 &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;033&#41;&#44; decreasing a median of 59 points during transfer&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The S&#47;F ratio prior to transfer was &#8804;150 in 4 infants &#40;128&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>27&#46;6&#41;&#44; who were diagnosed with bronchiolitis&#46; Chest radiography was performed in only two of these patients and in both the presence of unilateral infiltrates was seen&#46; Their S&#47;F prior to transfer was 136&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>18&#46;6&#46; Both infants were transferred with Helmet interface and Boussignac&#174; CPAP &#40;Vygon&#44; Ecouen&#44; France&#41;&#46; They both received CPAP as respiratory support in PICU&#46; These patients did not present cyanotic heart disease or chronic lung disease&#46; Using Kaplan&#8211;Meier analysis&#44; no differences were found in duration of total &#40;i&#46;e&#46; invasive and non-invasive&#41; ventilation between these two patients and the rest of the population&#58; 3 &#91;95&#37; CI&#58; 3&#8211;-&#93; days for patients with S&#47;F &#8804;150 and unilateral infiltrates vs&#46; 2 &#91;95&#37; CI&#58; 1&#46;3&#8211;5&#93; for the rest &#40;Log Rank test&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;930&#41;&#46; The median length of stay in PICU was 3&#46;5 &#91;95&#37; CI&#58; 3&#46;5&#8211;-&#93; days for patients with S&#47;F &#8804;150 and unilateral infiltrates vs&#46; 4 &#91;95&#37; CI&#58; 3&#8211;7&#93; for the rest &#40;Log Rank test&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;259&#41;&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">A good correlation between the partial pressure of oxygen&#47;fraction of inspired oxygen ratio and the S&#47;F has been demonstrated&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> A ratio S&#47;F &#8804;150 is required for the diagnosis of severe ARDS&#44; and it is independently associated with the need for endotracheal intubation&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> Invasive ventilation was not initiated in patients with S&#47;F ratio before transfer &#8804;150 and unilateral infiltrate because they did not meet ARDS criteria according to the current definitions at that time&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2&#44;3</span></a> In agreement with the new PALICC criteria&#44; the referred patients fulfilled the PARDS definition&#46; Invasive ventilation might have been considered as mandatory respiratory support during transport and in PICU&#46; However&#44; these patients presented a favourable evolution&#44; without the need for endotracheal intubation or a longer duration of ventilatory support or PICU length of stay&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Using autopsy findings as the gold standard&#44; AECC Barcelona definition showed good diagnostic accuracy &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; In adults&#44; the Turig-Good weight of evidence &#40;WOE&#41; was 6&#46;71 decibans &#40;dB&#41; for a positive result&#44; and for a negative result WOE was &#8722;5&#46;26<span class="elsevierStyleHsp" style=""></span>dB<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a>&#59; and in children&#44; the WOE for a positive was 7&#46;52<span class="elsevierStyleHsp" style=""></span>dB and for a negative was &#8722;6&#46;47<span class="elsevierStyleHsp" style=""></span>dB&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> In order to gain clinical usefulness&#44; the Berlin definition lost accuracy in confirming ARDS diagnosis &#40;for a positive the WOE was only 1&#46;52<span class="elsevierStyleHsp" style=""></span>dB&#41;&#44; but retained accuracy in discarding what is NOT an ARDS&#58; WOE for a negative was &#8722;11&#46;90<span class="elsevierStyleHsp" style=""></span>dB &#40;95&#37; CI<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;15&#46;56 to &#8722;6&#46;37&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a></p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">Because of this clinical observation&#44; in our opinion the PALICC definition is susceptible to producing false positive rates&#44; so the finding of bilateral infiltrates should be reconsidered as an essential tool for the diagnosis of PARDS&#46; If we follow the new paediatric recommendations&#44; only unilateral pulmonary infiltrates on chest radiograph&#44; we will lose the base of our best knowledge&#58; how to know&#44; accurately and confidently&#44; which hypoxaemic respiratory failure is NOT an ARDS&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> We consider the finding of unilateral infiltrates a point of controversy that requires further validation in prospective cohort studies&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0035" class="elsevierStylePara elsevierViewall">This research did not receive any specific grant from funding agencies in the public commercial&#44; or not-for-profit sectors&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflict of interest</span><p id="par0040" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interest&#46;</p></span></span>"
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          "leyenda" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">LR&#58; Likelihood Ratio&#59; WOE&#58; Turing-Good weight of evidence&#59; 95&#37; CI&#58; 95&#37; confidence interval&#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-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Accuracy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="4" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">AECC Barcelona 1994</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Berlin 2013</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">For adults<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a></th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">For children<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a></th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">For adults<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a></th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">95&#37; CI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">95&#37; CI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">95&#37; CI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="7" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">For a positive</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>LR&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;69&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;14&#8211;6&#46;83&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;03&#8211;18&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;27&#8211;1&#46;55&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>WOE&#43; &#40;decibans&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#46;71&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;97&#8211;8&#46;35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#46;52&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;15&#8211;12&#46;65&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;52&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;04&#8211;1&#46;90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="7" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">For a negative</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>LR&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;20&#8211;0&#46;43&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;08&#8211;0&#46;95&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;06&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;03&#8211;0&#46;23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>WOE&#8722; &#40;decibans&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;5&#46;26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;6&#46;89 to &#8722;3&#46;66&nbsp;\t\t\t\t\t\t\n
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