Description and study of risk factors for the diagnostic delay of paediatric inflammatory bowel disease

array:23 ["pii" => "S2341287915000435" "issn" => "23412879" "doi" => "10.1016/j.anpede.2015.03.004" "estado" => "S300" "fechaPublicacion" => "2015-04-01" "aid" => "1664" "copyright" => "Asociación Española de Pediatría" "copyrightAnyo" => "2014" "documento" => "article" "subdocumento" => "fla" "cita" => "An Pediatr (Barc). 2015;82:247-54" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 1792 "formatos" => array:3 [ "EPUB" => 130 "HTML" => 1240 "PDF" => 422 ] ] "Traduccion" => array:1 [ "es" => array:18 [ "pii" => "S169540331400321X" "issn" => "16954033" "doi" => "10.1016/j.anpedi.2014.05.024" "estado" => "S300" "fechaPublicacion" => "2015-04-01" "aid" => "1664" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "An Pediatr (Barc). 2015;82:247-54" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 4461 "formatos" => array:3 [ "EPUB" => 116 "HTML" => 3596 "PDF" => 749 ] ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "Original" "titulo" => "Retraso diagnóstico en la enfermedad inflamatoria intestinal pediátrica. Descripción y estudio de los factores de riesgo" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "247" "paginaFinal" => "254" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Description and study of risk factors for the diagnostic delay of pediatric inflammatory bowel disease" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1753 "Ancho" => 1624 "Tamanyo" => 132680 ] ] "descripcion" => array:1 [ "es" => "Tiempo hasta el diagnóstico en función del tipo de enfermedad." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J.V. Arcos-Machancoses, E. Donat-Aliaga, B. Polo-Miquel, E. Masip-Simó, C. Ribes-Koninckx, A. Pereda-Pérez" "autores" => array:6 [ 0 => array:2 [ "nombre" => "J.V." "apellidos" => "Arcos-Machancoses" ] 1 => array:2 [ "nombre" => "E." "apellidos" => "Donat-Aliaga" ] 2 => array:2 [ "nombre" => "B." "apellidos" => "Polo-Miquel" ] 3 => array:2 [ "nombre" => "E." "apellidos" => "Masip-Simó" ] 4 => array:2 [ "nombre" => "C." "apellidos" => "Ribes-Koninckx" ] 5 => array:2 [ "nombre" => "A." "apellidos" => "Pereda-Pérez" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2341287915000435" "doi" => "10.1016/j.anpede.2015.03.004" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287915000435?idApp=UINPBA00005H" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S169540331400321X?idApp=UINPBA00005H" "url" => "/16954033/0000008200000004/v2_201503280522/S169540331400321X/v2_201503280522/es/main.assets" ] ] "itemSiguiente" => array:18 [ "pii" => "S234128791500040X" "issn" => "23412879" "doi" => "10.1016/j.anpede.2015.03.001" "estado" => "S300" "fechaPublicacion" => "2015-04-01" "aid" => "1734" "copyright" => "Asociación Española de Pediatría" "documento" => "article" "subdocumento" => "fla" "cita" => "An Pediatr (Barc). 2015;82:255-66" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 3659 "formatos" => array:3 [ "EPUB" => 149 "HTML" => 2939 "PDF" => 571 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "Original Article" "titulo" => "Quantitative analysis of nutrient intake in children under 3 years old. ALSALMA study" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "255" "paginaFinal" => "266" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Análisis cuantitativo de la ingesta de nutrientes en niños menores de 3 años. Estudio ALSALMA" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1269 "Ancho" => 3258 "Tamanyo" => 220405 ] ] "descripcion" => array:1 [ "en" => "Mean percentage of adherence to DRIs (RDAs) in the daily nutrient intake. An adequate adherence to DRIs (RDA/AI) corresponds to a 100% adherence (horizontal line at 100%). Values below 100% represent energy or nutrient intakes below the recommended values. Values above 100% represent energy or nutrient intakes above the recommended values." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J. Dalmau, L. Peña-Quintana, A. Moráis, V. Martínez, V. Varea, M.J. Martínez, B. Soler" "autores" => array:7 [ 0 => array:2 [ "nombre" => "J." "apellidos" => "Dalmau" ] 1 => array:2 [ "nombre" => "L." "apellidos" => "Peña-Quintana" ] 2 => array:2 [ "nombre" => "A." "apellidos" => "Moráis" ] 3 => array:2 [ "nombre" => "V." "apellidos" => "Martínez" ] 4 => array:2 [ "nombre" => "V." "apellidos" => "Varea" ] 5 => array:2 [ "nombre" => "M.J." "apellidos" => "Martínez" ] 6 => array:2 [ "nombre" => "B." "apellidos" => "Soler" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S169540331400455X" "doi" => "10.1016/j.anpedi.2014.09.017" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S169540331400455X?idApp=UINPBA00005H" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S234128791500040X?idApp=UINPBA00005H" "url" => "/23412879/0000008200000004/v2_201505130138/S234128791500040X/v2_201505130138/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S2341287915000460" "issn" => "23412879" "doi" => "10.1016/j.anpede.2015.03.007" "estado" => "S300" "fechaPublicacion" => "2015-04-01" "aid" => "1659" "copyright" => "Asociación Española de Pediatría" "documento" => "article" "subdocumento" => "fla" "cita" => "An Pediatr (Barc). 2015;82:242-6" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 2214 "formatos" => array:3 [ "EPUB" => 137 "HTML" => 1482 "PDF" => 595 ] ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "Original Article" "titulo" => "Viral respiratory tract infections in the neonatal intensive care unit" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "242" "paginaFinal" => "246" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Infecciones virales de las vías respiratorias en la Unidad de Cuidados Intensivos Neonatales" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "E. Gonzalez-Carrasco, C. Calvo, M.L. García-García, M. Beato, C. Muñoz-Archidona, F. Pozo, I. Casas" "autores" => array:7 [ 0 => array:2 [ "nombre" => "E." "apellidos" => "Gonzalez-Carrasco" ] 1 => array:2 [ "nombre" => "C." "apellidos" => "Calvo" ] 2 => array:2 [ "nombre" => "M.L." "apellidos" => "García-García" ] 3 => array:2 [ "nombre" => "M." "apellidos" => "Beato" ] 4 => array:2 [ "nombre" => "C." "apellidos" => "Muñoz-Archidona" ] 5 => array:2 [ "nombre" => "F." "apellidos" => "Pozo" ] 6 => array:2 [ "nombre" => "I." "apellidos" => "Casas" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S1695403314003166" "doi" => "10.1016/j.anpedi.2014.05.023" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1695403314003166?idApp=UINPBA00005H" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287915000460?idApp=UINPBA00005H" "url" => "/23412879/0000008200000004/v2_201505130138/S2341287915000460/v2_201505130138/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "Original Article" "titulo" => "Description and study of risk factors for the diagnostic delay of paediatric inflammatory bowel disease" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "247" "paginaFinal" => "254" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "J.V. Arcos-Machancoses, E. Donat-Aliaga, B. Polo-Miquel, E. Masip-Simó, C. Ribes-Koninckx, A. Pereda-Pérez" "autores" => array:6 [ 0 => array:2 [ "nombre" => "J.V." "apellidos" => "Arcos-Machancoses" ] 1 => array:2 [ "nombre" => "E." "apellidos" => "Donat-Aliaga" ] 2 => array:2 [ "nombre" => "B." "apellidos" => "Polo-Miquel" ] 3 => array:2 [ "nombre" => "E." "apellidos" => "Masip-Simó" ] 4 => array:2 [ "nombre" => "C." "apellidos" => "Ribes-Koninckx" ] 5 => array:4 [ "nombre" => "A." "apellidos" => "Pereda-Pérez" "email" => array:1 [ 0 => "aperedap@outlook.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Unidad de Gastroenterología y Hepatología Pediátrica, Hospital Universitario y Politécnico La Fe, Valencia, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Retraso diagnóstico en la enfermedad inflamatoria intestinal pediátrica. Descripción y estudio de los factores de riesgo" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1739 "Ancho" => 1624 "Tamanyo" => 132840 ] ] "descripcion" => array:1 [ "en" => "Time elapsed until diagnosis by type of disease." ] ] ] "textoCompleto" => "IntroductionThe onset of inflammatory bowel disease (IBD) usually occurs at around 20–30 years of age, and is therefore considered a young adult disease. However, there is a subset of patients in whom onset occurs during childhood that, depending on the published series, amounts to 20–25% of the total.<a class="elsevierStyleCrossRef" href="#bib0140">1</a>In the past 20 years there has been an increase in the incidence of Crohn's disease (CD), while the number of ulcerative colitis (UC) diagnoses has remained stable or declined. This phenomenon seems to apply to childhood cases as well.<a class="elsevierStyleCrossRef" href="#bib0145">2</a> The diagnosis of IBD, especially in this age group, may be a considerable challenge due to the symptom overlap with functional bowel disorders and its variable clinical expression.It has been described that isolated ileal involvement in CD and consumption of anti-inflammatory agents and male sex in UC are risk factors for diagnostic delay (DD).<a class="elsevierStyleCrossRef" href="#bib0150">3</a> There is little evidence on the patient characteristics that contribute to a longer DD in children with IBD. Some analyses based on European registries concluded that younger children and children with ileal CD experience the longest delays in diagnosis.<a class="elsevierStyleCrossRef" href="#bib0155">4</a>IBD comprises a group of chronic and incurable diseases, and there is evidence that delays in the initiation of treatment are associated with poorer responses to it and with a more severe course of disease.<a class="elsevierStyleCrossRefs" href="#bib0160">5–8</a> Nearly 20% of patients younger than 16 years diagnosed with CD have growth delay or a short stature. The proportion in UC patients ranges from 5% to 10%.<a class="elsevierStyleCrossRef" href="#bib0180">9</a> Children may catch up in weight and height with pharmacological and nutritional treatment, but there is also evidence that a prolonged DD influences the final height of children with CD and facilitates the proximal extension of UC.<a class="elsevierStyleCrossRef" href="#bib0185">10</a> Furthermore, the diagnosis of IBD in a child or adolescent has a negative impact not only on physical aspects, but also has a negative psychological, familial and social impact.<a class="elsevierStyleCrossRef" href="#bib0190">11</a>For the above reasons, early diagnosis is considered a crucial element in the appropriate management of paediatric IBD. Our aim was to study the duration of DD in patients in our setting in order to describe its main stages, identify the main factors at play, and propose corrective measures.Patients and methodsWe conducted a retrospective study with the main objective of describing DD in paediatric IBD in our setting. We set out to determine the time elapsed between the main care milestones: T1, time elapsed between the onset of symptoms and the first medical visit; T2, time elapsed between referral to the hospital and the first appointment with a specialist in paediatric gastroenterology; T3, time elapsed between the first hospital visit and the first digestive endoscopy; and T4, time elapsed between the first medical visit and the explicit documentation of the diagnosis in the medical records based on the clinical presentation, laboratory data, digestive endoscopy and histopathology. We defined DD as equivalent to T4 and considered that DD was relevant for T4 values above the 75th percentile of each diagnostic group (UC, CD, and unspecified IBD [IBD-U]).The secondary objectives were to identify the work setting and degree of specialisation of the first doctor seen by the patient and of the doctor that made the referral to the specialist, as well as the risk factors for having a relevant DD. To this end, we collected data pertaining to the clinical presentation, use of diagnostic tools, and extent of disease at the time of diagnosis according to the new Paris classification.<a class="elsevierStyleCrossRef" href="#bib0195">12</a>Any enthesitis and arthritis suspected to be an extraintestinal manifestation of IBD was confirmed by a paediatric rheumatologist. The severity of disease flares was evaluated by means of the Paediatric Ulcerative Colitis Activity Index (PUCAI)<a class="elsevierStyleCrossRef" href="#bib0200">13</a> and the Paediatric Crohn's Disease Activity Index (PCDAI).<a class="elsevierStyleCrossRef" href="#bib0205">14</a>We identified patients younger than 18 years diagnosed with IBD from the database of the clinical documentation department of our hospital. The main sources of data were the paper medical records, supplemented by electronic record files in both our hospital's database, set up in 2010, and the primary care (PC) system database, which allowed for a better description of the time preceding the first contact at the hospital.We entered the data in a database created specifically for the purpose (Microsoft Access 2010). The statistical analysis was performed with the SPSS 19.0 software. Qualitative data were expressed as frequencies and percentages. The Kolmogorov–Smirnov test revealed a non-normal distribution of the quantitative variables under study, so we summarised these data using the median and the 95% confidence interval (CI), the interquartile range (IQR) and the minimum and maximum values. We used the χ2 test to analyse the association between qualitative variables and the Mann–Whitney U nonparametric test to compare quantitative data, with the main purpose of finding the differences between the CD and UC subgroups. We used the Bonferroni post hoc test for the multiple univariate ANOVA in our assessment of risk factors. The distribution of T4 for the whole sample and for CD and UC patients separately had a skewed shape with a marked right tail, which we modified by logarithmic transformation. This allowed for the use of multiple linear regression methods in our search for factors contributing to DD. The Kaplan–Meier analysis of the main variable is shown in <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>, and the differences in elapsed time by type of IBD were assessed by means of the Mantel–Cox test (log rank), based on the χ2 for equivalence of the survival distributions. We set the level of statistical significance at P<.05.<elsevierMultimedia ident="fig0005"></elsevierMultimedia>ResultsWe found data for 53 patients between January 2000 and January 2012. The cohort included 31 children with CD (58.5%), 19 with a final diagnosis of UC (35.8%) and 6 with IBD-U at the beginning of the inclusion period, 3 of which were later diagnosed as UC during the follow-up and included in the UC group for the statistical analysis.The median age at diagnosis was 10.75 years for CD, 7.75 years for UC, and 8.83 years for IBD-U. We found a significantly higher percentage of male patients among CD cases (83.9%) compared to UC cases (47.4%) and found no differences in the home setting of the children (rural vs urban) or the prevalence of smoking at the home. We did find that family histories of IBD were more common in UC patients than in CD patients (26.3% vs 13.3%).<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> summarises the symptoms at the onset of disease. We must note that all patients had intestinal symptoms at diagnosis (diarrhoea, rectal bleeding or abdominal pain), while extraintestinal manifestations were present in seven (13.2%): one patient with CU had erythema nodosum and another sclerosing cholangitis, and five CD patients had arthritis/enthesitis. Constitutional symptoms such as weight loss, fever and asthenia occurred more frequently in CD versus UC patients (a difference that did not reach statistical significance) and always in combination with digestive symptoms. Only one patient with CD had isolated abdominal pain at the onset. None of the children exhibited growth delay as the sole clinical manifestation at the onset.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>Seven cases were diagnosed before 5 years of age (13.2%: 4 with UC, 2 with CD and 1 with IBD-U) and all had onset with diarrhoea and abdominal pain. When we stratified by age and analysed CD and UC separately we did not find significant differences in the initial symptoms, although we observed a trend towards greater growth delay in children younger than 5 years.A colonoscopy was performed in every child in the cohort. Due to technical limitations, ileoscopies were performed satisfactorily in only 58.1% of CD patients. None of the UC patients were considered for an upper GI endoscopy, but a barium enema was performed in 36.8% of these patients at some point during their follow-up, mostly due to an incomplete colonoscopy during the diagnostic process. Magnetic resonance enterography was performed in 74.2% of CD patients, especially in cases diagnosed in later years, compared to 15.8% of UC patients. Examination by capsule endoscopy was also more frequent in CD patients (61.3%). Only one patient that was finally diagnosed with UC underwent this procedure while still diagnosed with IBD-U.<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows the distribution of UC and CD cases into the subgroups defined by the new Paris classification. We were able to retrieve information on the extent of the disease for every patient with CD and UC. We only lacked sufficient data to determine the severity of the first flare of the disease for two patients with UC that had been transferred from other hospitals.<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>The number of visits made to the emergency department for clinical features attributable to IBD before diagnosis was low, with a median of one visit for both CD and UC patients. However, 71.4% of the children were seen at least once in hospital emergency departments, which resulted in 26% of the referrals to the paediatric gastroenterology department. Most referrals to the specialist were made from PC (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>). A gastroenterologist was the first doctor to see the patient in only one case. While only 6% of the patients were first seen by hospital paediatricians that did not specialise in gastroenterology, these providers made the referral to the specialist in 22% of the cases.<elsevierMultimedia ident="tbl0015"></elsevierMultimedia>Children who first sought care for their IBD symptoms in a PC setting experienced a longer DD than children who were initially assessed in a hospital emergency department, with a median DD of 26 weeks (IQR, 11.5–78) versus 3 weeks (IQR, 1.5–5). However, patients first seen in PC had delayed growth less frequently (37.5% vs 69%), clinical features that were less specific, and higher T2 values. Thus, if the patient was referred from PC, the median time to referral was 2 weeks, with an IQR of 1–4 weeks and a maximum of 10 weeks, while referrals from the emergency department (in all cases, from our hospital) never took longer than one week. The distribution by age was similar in both groups (RIQ of 7.5–11.7 years for PC and 8.6–11.4 years for the emergency department).The median time elapsed from the initial symptoms of IBD to the first visit to a doctor was 2 weeks (95% CI, 1–2; RIQ, 1–3 weeks). There was a median delay of 12 weeks between this first visit and the definitive diagnosis (95% CI, 5–24 weeks; RIQ, 3–48 weeks). The rest of the time intervals is presented in <a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>. We did not find differences in any of the 4 time intervals studied when we analysed UC and CD separately. There was no difference in DD between UC and CD patients when we applied survival analysis methods (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). We considered DD relevant if it exceeded 38 weeks in UC patients and starting at 51 weeks in CD patients. Delays longer than one year occurred in 26.3% of UC patients and 25.8% of CD patients.<elsevierMultimedia ident="tbl0020"></elsevierMultimedia>The univariate analysis (<a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a>) revealed that age below 5 years was the only factor with a significant influence on DD in IBD-U. At any rate, the significance of this finding disappeared once the Bonferroni corrections were applied. The multiple linear regression analysis did not identify any variables significantly associated with the duration of DD nor a satisfactory model for its prediction. We also found no associations when we used the median T4 as a measure of the DD.<elsevierMultimedia ident="tbl0025"></elsevierMultimedia>DiscussionWe present a series of 53 patients with characteristics similar to those described in the literature for IBD-U.<a class="elsevierStyleCrossRef" href="#bib0210">15</a> We found a proportion of male CD patients (83.9%) that was above what was previously described in the literature.<a class="elsevierStyleCrossRef" href="#bib0215">16</a> Our results corroborate that abdominal pain is the typical presentation in paediatric patients, unlike in adults, in whom isolated diarrhoea is more frequent.<a class="elsevierStyleCrossRef" href="#bib0215">16</a> Growth delay, reflected by a one- or two-standard deviation drop relative to the previous stature, was observed in 45.2% of CD patients before the IBD diagnosis. The cause of growth failure is multifactorial and is closely associated with the disease's inflammatory activity, which would explain the higher probability of finding it in cases with longer DDs.<a class="elsevierStyleCrossRef" href="#bib0220">17</a> This is supported by the greater frequency of growth failure found in our population among children diagnosed before 5 years of age. Considering the problems that derive from this complication, including its psychosocial impact, the possibility of specific hormonal treatment should be evaluated by a paediatric endocrinologist in adherence with the pertinent recommendations.<a class="elsevierStyleCrossRef" href="#bib0225">18</a>A positive family history of IBD was found more frequently in UC patients than in CD patients, and only one of the nine patients with affected first-degree relatives had a relevant DD, which suggests that a positive family history may increase the degree of suspicion for IBD.The trend towards greater growth delay in cases with relevant DDs suggests that early diagnosis is crucial in children with IBD. Growth delay affected 50% of children with CD who were diagnosed after more than 6 months.Endoscopy is the gold standard for the initial examination of patients with suspected IBD according to the protocol established by the European Society for Paediatric Gastroenterology, Hepatology and Nutrition.<a class="elsevierStyleCrossRef" href="#bib0230">19</a> The Porto criteria established that in addition to an ileonoscopy, an upper gastrointestinal endoscopy (UGIE) and multiple biopsies should be performed to determine the extent of the disease more precisely and to minimise the possibility of a IBD-U diagnosis.<a class="elsevierStyleCrossRef" href="#bib0235">20</a> Despite having performed an UGIE in only 5 patients, our proportion of IBD-U is not similar to the figures reported in the literature.<a class="elsevierStyleCrossRef" href="#bib0240">21</a> The main limitation of our study was the incomplete diagnosis according to the Porto criteria, which may have led to a bias in the subclassification of the extent and behaviour of the disease, and therefore in the assessment of risk factors for DD.Previous studies have shown a high variation in the duration of DD, which is usually longer than the delay found in our study. The EPIMAD registry reports time elapsed between onset of symptoms and diagnosis of 2 months for UC and 4 months for CD in some regions in France.<a class="elsevierStyleCrossRef" href="#bib0145">2</a> The DD was greater than 4 months in a prospective population study in Norway.<a class="elsevierStyleCrossRef" href="#bib0245">22</a> A study of British children with IBD reported mean DDs of 4 (UC) and 5 months (CD).<a class="elsevierStyleCrossRef" href="#bib0250">23</a> The data of the national Italian registry of paediatric IBD show DDs of 6 months for UC and 10 months for CD.<a class="elsevierStyleCrossRef" href="#bib0255">24</a> The CEDATA registry in Germany and Austria, which collected retrospective and prospective data on 2604 children from before 1995 through August 2009, found a decreasing trend in DD in recent years, with the median DD declining to 2.5 months between 2008 and 2009.<a class="elsevierStyleCrossRef" href="#bib0155">4</a> This epidemiological study concluded that DD was greater in younger patients and in patients with small bowel CD. These data are consistent with those of other studies that were not specifically designed to assess DD.<a class="elsevierStyleCrossRef" href="#bib0260">25</a>The median DD in children with IBD is 12 weeks. The mean DD, on the other hand, is 31.6 weeks, which shows the influence of extremely large values in the distribution.In CD patients, stricturing or penetrating behaviour and large bowel involvement are associated to shorter DDs.<a class="elsevierStyleCrossRef" href="#bib0155">4</a> While our data also showed a trend towards a shorter DD in those conditions, the finding was not statistically significant. Our series included 51.6% of purely inflammatory forms of the disease, compared to the 80–90% reported in other studies.<a class="elsevierStyleCrossRef" href="#bib0265">26</a> The greater proportion of more severe forms of the disease may have resulted in more noticeable clinical features and a shorter DD.Another factor that may have contributed to the shorter DD in our study is that the median age of our patients was slightly higher than the median ages in other series,<a class="elsevierStyleCrossRefs" href="#bib0140">1,4</a> which may lead to an earlier presumptive diagnosis. Thus, there was a trend towards a greater prevalence of relevant DD in children younger than 5 years compared to older children, which was possibly due to a lesser degree of suspicion and less specific symptoms in the younger group.One possible explanation for the fact that 26% of the patients referred to the specialist were referred from the hospital emergency department is that there would be a higher degree of suspicion in this setting because these cases would presumably be more severe, or because the department has a closer association with the paediatric gastroenterology specialist. On the other hand, nearly three-quarters of the patients sought emergency care in a hospital at some point, which presented the opportunity of referring this majority of patients to a specialist if it had not already been done by the healthcare centre.A multicentre study based on the CEDATA registry demonstrated that the referring centre had an effect on the duration of DD.<a class="elsevierStyleCrossRef" href="#bib0155">4</a> This finding seems to support that DD is not only determined by the characteristics of the patient, but also by factors related to the doctor providing care and the setting or conditions in which the doctor works. In an adult case series, the DD attributed to doctor-related factors was more pronounced in cases of CD than of UC<a class="elsevierStyleCrossRef" href="#bib0150">3</a>; however, our study showed a similar effect in both diseases. A greater degree of suspicion of CD in our setting may account for this finding. Thus, the time elapsed before the first medical visit seems to be determined by the clinical and social characteristics of the patient, and factors relating to health providers seem to be at play in subsequent time intervals.The information contained in the medical records sufficed to conduct this study, although its retrospective design may have influenced the correct determination of the interval limits, especially the beginning of T4, that is, the time elapsed between the first doctor–patient contact and the suspicion of IBD. Furthermore, the sample size has limited the possibility of identifying risk profiles for relevant DD.To conclude, the duration of DD in our series was slightly shorter than those reported in previous studies, which we attribute to our sample being more recent and to the likelihood of a greater knowledge of IBD in the PC and hospital emergency departments. Nevertheless, the fact that there were a large number of children with DDs exceeding one year shows that there is still room for improvement in the time intervals that depend on healthcare providers.A method similar to the one applied in a recent study of colorectal cancer in adults<a class="elsevierStyleCrossRef" href="#bib0270">27</a> could help identify missed chances for diagnosis. A prospective multicentre observational study similar to the ongoing study of the Sociedad Española de Gastroenterología, Hepatología y Nutrición Pediátrica (Spanish Society of Paediatric Gastroenterology, Hepatology and Nutrition) could be the most suitable design to identify at-risk patients, obtain a more accurate description of DD in a larger population, and achieve our ultimate goal: the implementation of corrective measures and improvement in disease outcomes.Conflicts of interestThe authors have no conflicts of interest to declare." "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres502751" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Patients and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec523910" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres502752" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Pacientes y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec523909" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Patients and methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflicts of interest" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2014-05-05" "fechaAceptado" => "2014-05-29" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec523910" "palabras" => array:3 [ 0 => "Diagnostic delay" 1 => "Inflammatory bowel disease" 2 => "Primary care" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec523909" "palabras" => array:3 [ 0 => "Retraso diagnóstico" 1 => "Enfermedad inflamatoria intestinal" 2 => "Atención primaria" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "IntroductionDiagnostic delay of inflammatory bowel disease in children might be responsible for complications and a poor response to treatment. The study of diagnostic delay and its determining factors may help implement corrective measures and improve the prognosis of the disease. Patients and methodsA retrospective study of the information collected from primary care medical records and that from the paediatric gastroenterology service at a tertiary hospital between 2000 and 2012 was carried out in 53 patients: 31 with Crohn's disease, 19 with ulcerative colitis, and 3 with unclassified paediatric inflammatory bowel disease. The main response variable was the interval from the first physician–patient contact to diagnosis. ResultsThe median time to diagnosis was 12 weeks (interquartile range 5–24). However for 26.3% of the ulcerative colitis cases and 25.8% of the Crohn's disease cases, the interval was longer than 1 year. There was a more marked delay trend in Crohn's disease cases, but it was not statistically significant. None of the evaluated risk factors were associated with a relevant diagnostic delay, although it tended to be longer in younger children. ConclusionsWhereas the median delay for paediatric inflammatory bowel disease seems to be acceptable, the diagnostic time spans are considerable for a large proportion of children with heterogeneous clinical characteristics. Further research into lost diagnostic opportunities needs to be carried out." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Patients and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "IntroducciónEl retraso diagnóstico (RD) de la enfermedad inflamatoria intestinal pediátrica (EII-P) puede conllevar la aparición de complicaciones y una menor respuesta al tratamiento. Estudiar el RD y los factores que lo condicionan ayudaría a implementar medidas correctoras y mejorar la evolución de la enfermedad. Pacientes y métodosUn total de 53 casos (31 de enfermedad de Crohn [EC], 19 de colitis ulcerosa [CU] y 3 EII-P no clasificadas) entre 2000 y 2012 se evaluaron de forma retrospectiva a través de la información recogida en las historias clínicas de atención primaria y las de un Servicio de Gastroenterología infantil de un hospital terciario. La variable respuesta principal fue el tiempo entre el primer contacto médico-paciente y el diagnóstico. ResultadosEl tiempo mediano de RD fue de 12 semanas (rango intercuartílico 5-24). Sin embargo, un 26,3% de las CU y un 25,8% de las EC presentaron un RD superior a un año. Ninguno de los factores de riesgo estudiados se asoció significativamente a un RD relevante pero los niños de menor edad presentaron una tendencia a un mayor RD. ConclusionesAunque el RD mediano de la EII-P parece aceptable, existe una proporción importante de niños con unas características clínicas heterogéneas y unos tiempos diagnósticos considerables. Se debería profundizar en el análisis de las oportunidades perdidas de diagnóstico." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Pacientes y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Arcos-Machancoses JV, Donat-Aliaga E, Polo-Miquel B, Masip-Simó E, Ribes-Koninckx C, Pereda-Pérez A. Retraso diagnóstico en la enfermedad inflamatoria intestinal pediátrica. Descripción y estudio de los factores de riesgo. An Pediatr (Barc). 2015;82:247–254." ] ] "multimedia" => array:6 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1739 "Ancho" => 1624 "Tamanyo" => 132840 ] ] "descripcion" => array:1 [ "en" => "Time elapsed until diagnosis by type of disease." ] ] 1 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:3 [ "leyenda" => "CD: Crohn's disease; UC: ulcerative colitis." "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">Ulcerative colitis \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">Crohn's disease \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">Undetermined colitis \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">P-value of the difference between UC and CD \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Frequency \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19/53 (35.8%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">31/53 (58.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3/53 (5.7%) \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 " align="left" valign="top">Age at diagnosis in years(median, IQR) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7.75 (5.25–11.71) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10.75 (9.08–12.92) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8.83 (3.08–12.08)<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.048 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Male sex \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9/19 (47.4%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">26/31 (83.9%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2/3 (66.7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.006 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Rural home setting \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2/19 (10.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1/29 (3.4%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2/3 (66.7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.322 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Family history \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5/19 (26.3%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4/30 (13.3%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0/3 (0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.253 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top">Clinical manifestations</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Diarrhoea \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18/19 (94.7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20/31 (64.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3/3 (100%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.015 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Weight loss \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10/19 (52.6%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19/31 (61.3%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2/3 (66.7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.547 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Rectal bleeding \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17/19 (89.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14/31 (45.2%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3/3 (100%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.002 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Abdominal pain \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16/19 (84.2%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30/31 (96.8%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3/3 (100%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.112 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Fever \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3/19 (15.8%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7/31 (22.6%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0/3 (0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.560 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Asthenia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13/19 (68.4%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22/31 (71.0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2/3 (66.7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.849 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Fistula \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0/19 (0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6/31 (19.4%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0/3 (0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.009 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Anal fissure \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0/19 (0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2/31 (6.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0/3 (0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.103 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Extraintestinal manifestations during the course of the disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2/19 (10.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5/31 (16.1%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0/3 (0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.579 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab802067.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "Median (maximum−minimum)." ] ] ] "descripcion" => array:1 [ "en" => "Demographic data and clinical manifestations at onset." ] ] 2 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:2 [ 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 " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Crohn's disease</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Age</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">A1a, younger than 10 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13/31 (41.9%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">A1b, between 10 and 17 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18/31 (58.1%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">A2, older than 17 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0/31 (0%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Extent</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">L1, ileal or limited caecal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11/31 (35.5%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">L2, colonic \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4/31 (12.9%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">L3, ileocolonic \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10/31 (32.3%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">L1+L4a, upper disease proximal to ligament of Treitz \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1/31 (3.2%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">L1+L4b, upper disease distal to ligament of Treitz and proximal to distal 1/3 ileum \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5/31 (16.1%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Behaviour</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">B1, inflammatory nonstricturing nonpenetrating \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16/31 (51.6%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">B2, stricturing \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9/31 (29%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">B2p, stricturing with perianal involvement \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2/31 (6.5%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">B3, penetrating \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1/31 (3.2%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">B3p, penetrating with perianal involvement \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2/31 (6.5%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">B2B3, stricturing-penetrating \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3/31 (9.7%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Growth</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">G0, no evidence of growth delay \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17/31 (54.8%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">G1, growth delay \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14/31 (45.2%) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab802068.png" ] ] 1 => 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 " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Ulcerative colitis</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Extent</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">E1, proctitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1/19 (5.3%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">E2, left sided UC (distal to splenic flexure) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4/19 (21.1%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">E3, extensive colitis (distal to hepatic flexure) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1/19 (5.3%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">E4, pancolitis (proximal to hepatic flexure) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13/19 (68.4%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Severity</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">S0, never severe \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11/17 (64.7%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">S1, ever severe \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6/17 (35.3%) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab802066.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Severity and extent of disease at the time of diagnosis as defined by the Paris classification." ] ] 3 => array:7 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">First doctor that cared for patient</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Doctor that referred to specialist</th></tr><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">Ulcerative colitis \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">Crohn's disease \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">Ulcerative colitis \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">Crohn's disease \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Primary care paediatrician \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11/19 (57.9%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18/31 (58.1%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6/19 (31.6%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10/31 (32.3%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Emergency department \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7/19 (36.8%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10/31 (32.3%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5/19 (26.3%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8/31 (25.8%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top">Hospital paediatrician</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Not specialised in paediatric gastroenterology \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0/19 (0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3/31 (9.7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5/19 (26.3%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6/31 (19.4%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"> Specialised in paediatric gastroenterology \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1/19 (5.3%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0/31 (0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3/19 (15.8%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7/31 (22.6%) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab802069.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Doctors involved in the diagnosis." ] ] 4 => array:7 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "CD: Crohn's disease; UC: ulcerative colitis." "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">Time in completed weeks \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Time elapsed between onset of symptoms and first medical visit</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Time elapsed between referral to hospital and first hospital visit</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Time elapsed between first hospital visit and first endoscopy</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Time elapsed between first medical visit and diagnosis</th></tr><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">CU \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">EC \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">CU \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">EC \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">CU \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">EC \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">CU \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">EC \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Cases \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">26 \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">26 \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">30 \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">30 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Minimum \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">1%ile \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">10%ile \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">25%ile \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">50%ile (95% CI) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (1–2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (2–3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (0–4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.5 (0–1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 (2–20) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (1–4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 (4–24) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 (3–32) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">75%ile \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.25 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">34 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">38 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">51 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">90%ile \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">113.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">116.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">103.9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Maximum \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 \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">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">152 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">208 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">152 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">208 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">P-value \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " colspan="2" align="center" valign="top">.110</td><td class="td" title="table-entry " colspan="2" align="center" valign="top">.243</td><td class="td" title="table-entry " colspan="2" align="center" valign="top">.068</td><td class="td" title="table-entry " colspan="2" align="center" valign="top">.877</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab802065.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Distribution of time to diagnosis for ulcerative colitis and Crohn's disease." ] ] 5 => array:7 [ "identificador" => "tbl0025" "etiqueta" => "Table 5" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "CD: Crohn's disease; CI: confidence interval; OR: odds ratio; UC: ulcerative colitis." "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">Diagnostic delay<75th percentile \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">Diagnostic delay>75th percentile \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">P-value \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">Diagnostic delay OR>75th percentile (95% CI) \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Weight loss \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20/38 (52.6%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11/15 (73.3%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.168 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.48 (0.67–9.17) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Age less than 5 years at onset \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2/38 (5.3%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5/15 (33.3%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.015 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9.00 (1.51–53.54) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Family history \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8/37 (21.6%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1/15 (6.7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.197 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.26 (0.03–2.28) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Extraintestinal manifestations \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6/38 (15.8%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1/15 (6.7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.377 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.38 (0.04–3.47) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Stricturing or penetrating behaviour in CD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12/23 (52.2%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3/8 (37.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.474 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.55 (0.11–2.86) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">First medical visit after one or more months since onset of clinical symptoms of CD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18/23 (78.3%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6/8 (75.0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.849 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.83 (0.13–5.47) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Small bowel involvement in CD (L1 or L1 + L4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14/23 (60.9%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3/8 (37.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.253 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.39 (0.07–2.03) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Ileal or ileocaecal involvement in CD (L1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10/23 (43.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1/8 (12.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.115 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.19 (0.02–1.77) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Presence of anal fistula in the first CD examination \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6/23 (26.1%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3/8 (37.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.540 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.70 (0.31–9.37) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Growth delay in CD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9/23 (39.1%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5/8 (62.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.253 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.59 (0.49–13.61) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">First medical visit after a month or more with clinical symptoms of UC \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12/13 (92.3%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4/6 (66.7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.154 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.17 (0.01–2.37) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Severe disease at onset of UC \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3/13 (23.1%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3/6 (50%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.241 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.33 (0.43–26.04) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab802064.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Univariate analysis. Clinical features at diagnosis: impact on diagnostic delay." ] ] ] "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" => "Increasing incidence of paediatric inflammatory bowel disease in Ontario, Canada: evidence from health administrative data" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E.I. Benchimol" 1 => "A. Guttman" 2 => "A.M. Griffiths" 3 => "L. Rabeneck" 4 => "D.R. Mack" 5 => "H. Brill" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/gut.2009.188383" "Revista" => array:6 [ "tituloSerie" => "Gut" "fecha" => "2009" "volumen" => "58" "paginaInicial" => "1490" "paginaFinal" => "1497" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19651626" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0145" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Incidence, clinical presentation and location at diagnosis of pediatric inflammatory bowel disease: a prospective population-based study in northern France (1988–1999)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S. Auvin" 1 => "F. Molinie" 2 => "C. Gower-Rousseau" 3 => "F. Brazier" 4 => "V. Merle" 5 => "B. Grandbastien" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Pediatr Gastroenterol Nutr" "fecha" => "2005" "volumen" => "41" "paginaInicial" => "49" "paginaFinal" => "55" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15990630" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0150" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Systematic evaluation of risk factors for diagnostic delay in inflammatory bowel disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S.R. Vavricka" 1 => "S.M. Spigaglia" 2 => "G. Rogler" 3 => "V. Pittet" 4 => "P. Michetti" 5 => "C. Felley" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/ibd.21719" "Revista" => array:6 [ "tituloSerie" => "Inflamm Bowel Dis" "fecha" => "2012" "volumen" => "18" "paginaInicial" => "496" "paginaFinal" => "505" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21509908" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0155" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Childhood onset inflammatory bowel disease: predictors of delayed diagnosis from the CEDATA German-language pediatric inflammatory bowel disease registry" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Timmer" 1 => "R. Behrens" 2 => "S. Buderus" 3 => "A. Findeisen" 4 => "A. Hauer" 5 => "K.M. Keller" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jpeds.2010.09.014" "Revista" => array:6 [ "tituloSerie" => "J Pediatr" "fecha" => "2011" "volumen" => "158" "paginaInicial" => "467" "paginaFinal" => "473" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21051046" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0160" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Early inflammatory bowel disease: different treatment response to specific or all medications?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J. Markowitz" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000228574" "Revista" => array:6 [ "tituloSerie" => "Dig Dis" "fecha" => "2009" "volumen" => "27" "paginaInicial" => "358" "paginaFinal" => "365" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19786765" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0165" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Are we giving azathioprine too late? The case for early immunomodulation in inflammatory bowel disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M.J. Etchevers" 1 => "M. Aceituno" 2 => "M. Sans" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "World J Gastroenterol" "fecha" => "2008" "volumen" => "14" "paginaInicial" => "5512" "paginaFinal" => "5518" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18810768" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0170" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effect of early immunomodulator use in moderate to severe pediatric Crohn disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. Punati" 1 => "J. Markowitz" 2 => "T. Lerer" 3 => "J. Hyams" 4 => "S. Kugathasan" 5 => "A. Griffiths" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/ibd.20412" "Revista" => array:6 [ "tituloSerie" => "Inflamm Bowel Dis" "fecha" => "2008" "volumen" => "14" "paginaInicial" => "949" "paginaFinal" => "954" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18306311" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0175" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Presentation and disease course in early-compared to later-onset pediatric Crohn's disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "N. Gupta" 1 => "A.G. Bostrom" 2 => "B.S. Kirschner" 3 => "S.A. Cohen" 4 => "O. Abramson" 5 => "G.D. Ferry" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1572-0241.2008.02000.x" "Revista" => array:6 [ "tituloSerie" => "Am J Gastroenterol" "fecha" => "2008" "volumen" => "103" "paginaInicial" => "2092" "paginaFinal" => "2098" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18796101" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0180" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Current diagnosis, management and morbidity in paediatric inflammatory bowel disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "C. Spray" 1 => "G.D. Debelle" 2 => "M.S. Murphy" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Acta Paediatr" "fecha" => "2001" "volumen" => "90" "paginaInicial" => "400" "paginaFinal" => "405" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11332930" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0185" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical features affecting final adult height in patients with pediatric-onset Crohn's disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A. Sawczenko" 1 => "A.B. Ballinger" 2 => "M.O. Savage" 3 => "I.R. Sanderson" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1542/peds.2005-2931" "Revista" => array:6 [ "tituloSerie" => "Pediatrics" "fecha" => "2006" "volumen" => "118" "paginaInicial" => "124" "paginaFinal" => "129" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16818557" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0190" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A meta-analytic review of the psychosocial adjustment of youth with inflammatory bowel disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R.N. Greenley" 1 => "K.A. Hommel" 2 => "J. Nebel" 3 => "T. Raboin" 4 => "S.H. Li" 5 => "P. Simpson" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/jpepsy/jsp120" "Revista" => array:6 [ "tituloSerie" => "J Pediatr Psychol" "fecha" => "2010" "volumen" => "35" "paginaInicial" => "857" "paginaFinal" => "869" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20123705" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0195" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pediatric modification of the Montreal classification for inflammatory bowel disease: the Paris classification" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Levine" 1 => "A. Griffiths" 2 => "J. Markowitz" 3 => "D.C. Wilson" 4 => "D. Turner" 5 => "R.K. Russell" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/ibd.21493" "Revista" => array:6 [ "tituloSerie" => "Inflamm Bowel Dis" "fecha" => "2011" "volumen" => "17" "paginaInicial" => "1314" "paginaFinal" => "1321" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21560194" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0200" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Development, validation, and evaluation of a pediatric ulcerative colitis activity index: a prospective multicentre study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D. Turner" 1 => "A.R. Otley" 2 => "D. Mack" 3 => "J. Hyams" 4 => "J. de Bruijne" 5 => "K. Uusoue" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1053/j.gastro.2007.05.029" "Revista" => array:6 [ "tituloSerie" => "Gastroenterology" "fecha" => "2007" "volumen" => "133" "paginaInicial" => "423" "paginaFinal" => "432" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17681163" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0205" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Development and validation of a pediatric Crohn's disease activity index" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.S. Hyams" 1 => "G.D. Ferry" 2 => "F.S. Mandel" 3 => "J.D. Gryboski" 4 => "P.M. Kibort" 5 => "B.S. Kirschner" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Pediatr Gastroenterol Nutr" "fecha" => "1991" "volumen" => "12" "paginaInicial" => "439" "paginaFinal" => "447" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1678008" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0210" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Searching for new clues in inflammatory bowel disease: tell tales from pediatric IBD natural history studies" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "S. Kugathasan" 1 => "S. Cohen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1053/j.gastro.2008.08.030" "Revista" => array:6 [ "tituloSerie" => "Gastroenterology" "fecha" => "2008" "volumen" => "135" "paginaInicial" => "1038" "paginaFinal" => "1041" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18786536" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0215" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Presenting features of inflammatory bowel disease in Great Britain and Ireland" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A. Sawczenko" 1 => "B.K. Sandhu" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arch Dis Child" "fecha" => "2003" "volumen" => "88" "paginaInicial" => "995" "paginaFinal" => "1000" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14612366" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0220" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mechanisms of growth impairment in pediatric Crohn's disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "T.D. Walters" 1 => "A.M. Griffiths" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1038/nrgastro.2009.124" "Revista" => array:6 [ "tituloSerie" => "Nat Rev Gastroenterol Hepatol" "fecha" => "2009" "volumen" => "6" "paginaInicial" => "513" "paginaFinal" => "523" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19713986" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0225" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Guidelines for the management of growth failure in childhood inflammatory bowel disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "R. Heuschkel" 1 => "C. Salvestrini" 2 => "R.M. Beattie" 3 => "H. Hildebrand" 4 => "T. Walters" 5 => "A. Griffiths" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/ibd.20378" "Revista" => array:6 [ "tituloSerie" => "Inflamm Bowel Dis" "fecha" => "2008" "volumen" => "14" "paginaInicial" => "839" "paginaFinal" => "849" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18266237" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0230" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Inflammatory bowel disease in children and adolescents: Recommendations for diagnosis – the Porto criteria" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.C. Escher" 1 => "J. Amil Dias" 2 => "K. Bouchenek" 3 => "S. Buderus" 4 => "M. Bueno de Mesquita" 5 => "Y. Bujanover" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Pediatr Gastroenterol Nutr" "fecha" => "2005" "volumen" => "41" "paginaInicial" => "1" "paginaFinal" => "7" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15990620" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0235" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Differentiating ulcerative colitis from Crohn disease in children and young adults: Report of a working group of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the Crohn's and Colitis Foundation of America" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Bousvaros" 1 => "D.A. Antonioli" 2 => "R.B. Colletti" 3 => "M.C. Dubinsky" 4 => "J.N. Glickman" 5 => "B.D. Gold" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/MPG.0b013e31805563f3" "Revista" => array:6 [ "tituloSerie" => "J Pediatr Gastroenterol Nutr" "fecha" => "2007" "volumen" => "44" "paginaInicial" => "653" "paginaFinal" => "674" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17460505" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0240" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Increasing incidence of pediatric inflammatory bowel disease in Spain (1996–2009): the SPIRIT Registry" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. Martín-de-Carpi" 1 => "A. Rodríguez" 2 => "E. Ramos" 3 => "S. Jiménez" 4 => "M.J. Martínez-Gómez" 5 => "E. Medina" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/ibd.22980" "Revista" => array:6 [ "tituloSerie" => "Inflamm Bowel Dis" "fecha" => "2013" "volumen" => "19" "paginaInicial" => "73" "paginaFinal" => "80" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22535573" "web" => "Medline" ] ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0245" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Incidence of inflammatory bowel disease in children in southeastern Norway: a prospective population-based study 1990–94" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "B.S. Bentsen" 1 => "B. Moum" 2 => "A. Ekbon" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Scand J Gastroenterol" "fecha" => "2002" "volumen" => "37" "paginaInicial" => "540" "paginaFinal" => "545" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12059055" "web" => "Medline" ] ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0250" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Natural history of paediatric inflammatory bowel disease over a 5-year follow-up: a retrospective review of data from the register of paediatric inflammatory bowel diseases" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E.A. Newby" 1 => "N.M. Croft" 2 => "M. Green" 3 => "K. Hassan" 4 => "R.B. Heuschkel" 5 => "H. Jenkins" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/MPG.0b013e3181596efd" "Revista" => array:6 [ "tituloSerie" => "J Pediatr Gastroenterol Nutr" "fecha" => "2008" "volumen" => "46" "paginaInicial" => "539" "paginaFinal" => "545" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18493209" "web" => "Medline" ] ] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0255" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Inflammatory bowel disease in children and adolescents in Italy: data from the pediatric national IBD register (1996–2003)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Castro" 1 => "B. Papadatou" 2 => "M. Baldassare" 3 => "F. Balli" 4 => "A. Barabino" 5 => "C. Barbera" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/ibd.20470" "Revista" => array:6 [ "tituloSerie" => "Inflamm Bowel Dis" "fecha" => "2008" "volumen" => "14" "paginaInicial" => "1246" "paginaFinal" => "1252" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18521916" "web" => "Medline" ] ] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0260" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "NOD2/CARD15 variants are associated with lower weight at diagnosis in children with Crohn's disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "G. Tomer" 1 => "C. Ceballos" 2 => "E. Concepcion" 3 => "K.J. Benkov" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1572-0241.2003.08673.x" "Revista" => array:6 [ "tituloSerie" => "Am J Gastroenterol" "fecha" => "2003" "volumen" => "98" "paginaInicial" => "2479" "paginaFinal" => "2484" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14638352" "web" => "Medline" ] ] ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0265" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Enfermedad inflamatoria intestinal (I): clasificación, etiología y clínica" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "E. Medina" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "An Pediatr Contin" "fecha" => "2013" "volumen" => "11" "paginaInicial" => "59" "paginaFinal" => "67" ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0270" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Oportunidades perdidas en el diagnóstico temprano del cáncer colorrectal sintomático" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M. Domínguez-Ayala" 1 => "J. Díez-Vallejo" 2 => "A. Comas-Fuentes" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Rev Esp Enferm Dig" "fecha" => "2012" "volumen" => "104" "paginaInicial" => "343" "paginaFinal" => "349" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22849494" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23412879/0000008200000004/v2_201505130138/S2341287915000435/v2_201505130138/en/main.assets" "Apartado" => array:4 [ "identificador" => "26005" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original Articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23412879/0000008200000004/v2_201505130138/S2341287915000435/v2_201505130138/en/main.pdf?idApp=UINPBA00005H&text.app=https://www.analesdepediatria.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287915000435?idApp=UINPBA00005H"]

Statistics

Original Article

Description and study of risk factors for the diagnostic delay of paediatric inflammatory bowel disease

Retraso diagnóstico en la enfermedad inflamatoria intestinal pediátrica. Descripción y estudio de los factores de riesgo

J.V. Arcos-Machancoses, E. Donat-Aliaga, B. Polo-Miquel, E. Masip-Simó, C. Ribes-Koninckx, A. Pereda-Pérez

Corresponding author

aperedap@outlook.com

Corresponding author.

Unidad de Gastroenterología y Hepatología Pediátrica, Hospital Universitario y Politécnico La Fe, Valencia, Spain

Read

6155

Times
was read the article

2104

Total PDF

4051

Total HTML

Share statistics

 array:23 [
  "pii" => "S2341287915000435"
  "issn" => "23412879"
  "doi" => "10.1016/j.anpede.2015.03.004"
  "estado" => "S300"
  "fechaPublicacion" => "2015-04-01"
  "aid" => "1664"
  "copyright" => "Asociaci&#243;n Espa&#241;ola de Pediatr&#237;a"
  "copyrightAnyo" => "2014"
  "documento" => "article"
  "subdocumento" => "fla"
  "cita" => "An Pediatr &#40;Barc&#41;. 2015;82:247-54"
  "abierto" => array:3 [
    "ES" => false
    "ES2" => false
    "LATM" => false
  ]
  "gratuito" => false
  "lecturas" => array:2 [
    "total" => 1792
    "formatos" => array:3 [
      "EPUB" => 130
      "HTML" => 1240
      "PDF" => 422
    ]
  ]
  "Traduccion" => array:1 [
    "es" => array:18 [
      "pii" => "S169540331400321X"
      "issn" => "16954033"
      "doi" => "10.1016/j.anpedi.2014.05.024"
      "estado" => "S300"
      "fechaPublicacion" => "2015-04-01"
      "aid" => "1664"
      "documento" => "article"
      "crossmark" => 1
      "subdocumento" => "fla"
      "cita" => "An Pediatr &#40;Barc&#41;. 2015;82:247-54"
      "abierto" => array:3 [
        "ES" => false
        "ES2" => false
        "LATM" => false
      ]
      "gratuito" => false
      "lecturas" => array:2 [
        "total" => 4461
        "formatos" => array:3 [
          "EPUB" => 116
          "HTML" => 3596
          "PDF" => 749
        ]
      ]
      "es" => array:13 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Original</span>"
        "titulo" => "Retraso diagn&#243;stico en la enfermedad inflamatoria intestinal pedi&#225;trica&#46; Descripci&#243;n y estudio de los factores de riesgo"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "tieneResumen" => array:2 [
          0 => "es"
          1 => "en"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "247"
            "paginaFinal" => "254"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Description and study of risk factors for the diagnostic delay of pediatric inflammatory bowel disease"
          ]
        ]
        "contieneResumen" => array:2 [
          "es" => true
          "en" => true
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 0
          "multimedia" => array:7 [
            "identificador" => "fig0005"
            "etiqueta" => "Figura 1"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "gr1.jpeg"
                "Alto" => 1753
                "Ancho" => 1624
                "Tamanyo" => 132680
              ]
            ]
            "descripcion" => array:1 [
              "es" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Tiempo hasta el diagn&#243;stico en funci&#243;n del tipo de enfermedad&#46;</p>"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "J&#46;V&#46; Arcos-Machancoses, E&#46; Donat-Aliaga, B&#46; Polo-Miquel, E&#46; Masip-Sim&#243;, C&#46; Ribes-Koninckx, A&#46; Pereda-P&#233;rez"
            "autores" => array:6 [
              0 => array:2 [
                "nombre" => "J&#46;V&#46;"
                "apellidos" => "Arcos-Machancoses"
              ]
              1 => array:2 [
                "nombre" => "E&#46;"
                "apellidos" => "Donat-Aliaga"
              ]
              2 => array:2 [
                "nombre" => "B&#46;"
                "apellidos" => "Polo-Miquel"
              ]
              3 => array:2 [
                "nombre" => "E&#46;"
                "apellidos" => "Masip-Sim&#243;"
              ]
              4 => array:2 [
                "nombre" => "C&#46;"
                "apellidos" => "Ribes-Koninckx"
              ]
              5 => array:2 [
                "nombre" => "A&#46;"
                "apellidos" => "Pereda-P&#233;rez"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S2341287915000435"
          "doi" => "10.1016/j.anpede.2015.03.004"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => false
            "ES2" => false
            "LATM" => false
          ]
          "gratuito" => false
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287915000435?idApp=UINPBA00005H"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S169540331400321X?idApp=UINPBA00005H"
      "url" => "/16954033/0000008200000004/v2_201503280522/S169540331400321X/v2_201503280522/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:18 [
    "pii" => "S234128791500040X"
    "issn" => "23412879"
    "doi" => "10.1016/j.anpede.2015.03.001"
    "estado" => "S300"
    "fechaPublicacion" => "2015-04-01"
    "aid" => "1734"
    "copyright" => "Asociaci&#243;n Espa&#241;ola de Pediatr&#237;a"
    "documento" => "article"
    "subdocumento" => "fla"
    "cita" => "An Pediatr &#40;Barc&#41;. 2015;82:255-66"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 3659
      "formatos" => array:3 [
        "EPUB" => 149
        "HTML" => 2939
        "PDF" => 571
      ]
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>"
      "titulo" => "Quantitative analysis of nutrient intake in children under 3 years old&#46; ALSALMA study"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "255"
          "paginaFinal" => "266"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "An&#225;lisis cuantitativo de la ingesta de nutrientes en ni&#241;os menores de 3 a&#241;os&#46; Estudio ALSALMA"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Figure 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 1269
              "Ancho" => 3258
              "Tamanyo" => 220405
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Mean percentage of adherence to DRIs &#40;RDAs&#41; in the daily nutrient intake&#46; An adequate adherence to DRIs &#40;RDA&#47;AI&#41; corresponds to a 100&#37; adherence &#40;horizontal line at 100&#37;&#41;&#46; Values below 100&#37; represent energy or nutrient intakes below the recommended values&#46; Values above 100&#37; represent energy or nutrient intakes above the recommended values&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "J&#46; Dalmau, L&#46; Pe&#241;a-Quintana, A&#46; Mor&#225;is, V&#46; Mart&#237;nez, V&#46; Varea, M&#46;J&#46; Mart&#237;nez, B&#46; Soler"
          "autores" => array:7 [
            0 => array:2 [
              "nombre" => "J&#46;"
              "apellidos" => "Dalmau"
            ]
            1 => array:2 [
              "nombre" => "L&#46;"
              "apellidos" => "Pe&#241;a-Quintana"
            ]
            2 => array:2 [
              "nombre" => "A&#46;"
              "apellidos" => "Mor&#225;is"
            ]
            3 => array:2 [
              "nombre" => "V&#46;"
              "apellidos" => "Mart&#237;nez"
            ]
            4 => array:2 [
              "nombre" => "V&#46;"
              "apellidos" => "Varea"
            ]
            5 => array:2 [
              "nombre" => "M&#46;J&#46;"
              "apellidos" => "Mart&#237;nez"
            ]
            6 => array:2 [
              "nombre" => "B&#46;"
              "apellidos" => "Soler"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S169540331400455X"
        "doi" => "10.1016/j.anpedi.2014.09.017"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => false
          "ES2" => false
          "LATM" => false
        ]
        "gratuito" => false
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S169540331400455X?idApp=UINPBA00005H"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S234128791500040X?idApp=UINPBA00005H"
    "url" => "/23412879/0000008200000004/v2_201505130138/S234128791500040X/v2_201505130138/en/main.assets"
  ]
  "itemAnterior" => array:18 [
    "pii" => "S2341287915000460"
    "issn" => "23412879"
    "doi" => "10.1016/j.anpede.2015.03.007"
    "estado" => "S300"
    "fechaPublicacion" => "2015-04-01"
    "aid" => "1659"
    "copyright" => "Asociaci&#243;n Espa&#241;ola de Pediatr&#237;a"
    "documento" => "article"
    "subdocumento" => "fla"
    "cita" => "An Pediatr &#40;Barc&#41;. 2015;82:242-6"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 2214
      "formatos" => array:3 [
        "EPUB" => 137
        "HTML" => 1482
        "PDF" => 595
      ]
    ]
    "en" => array:12 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>"
      "titulo" => "Viral respiratory tract infections in the neonatal intensive care unit"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "242"
          "paginaFinal" => "246"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Infecciones virales de las v&#237;as respiratorias en la Unidad de Cuidados Intensivos Neonatales"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "E&#46; Gonzalez-Carrasco, C&#46; Calvo, M&#46;L&#46; Garc&#237;a-Garc&#237;a, M&#46; Beato, C&#46; Mu&#241;oz-Archidona, F&#46; Pozo, I&#46; Casas"
          "autores" => array:7 [
            0 => array:2 [
              "nombre" => "E&#46;"
              "apellidos" => "Gonzalez-Carrasco"
            ]
            1 => array:2 [
              "nombre" => "C&#46;"
              "apellidos" => "Calvo"
            ]
            2 => array:2 [
              "nombre" => "M&#46;L&#46;"
              "apellidos" => "Garc&#237;a-Garc&#237;a"
            ]
            3 => array:2 [
              "nombre" => "M&#46;"
              "apellidos" => "Beato"
            ]
            4 => array:2 [
              "nombre" => "C&#46;"
              "apellidos" => "Mu&#241;oz-Archidona"
            ]
            5 => array:2 [
              "nombre" => "F&#46;"
              "apellidos" => "Pozo"
            ]
            6 => array:2 [
              "nombre" => "I&#46;"
              "apellidos" => "Casas"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S1695403314003166"
        "doi" => "10.1016/j.anpedi.2014.05.023"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => false
          "ES2" => false
          "LATM" => false
        ]
        "gratuito" => false
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1695403314003166?idApp=UINPBA00005H"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287915000460?idApp=UINPBA00005H"
    "url" => "/23412879/0000008200000004/v2_201505130138/S2341287915000460/v2_201505130138/en/main.assets"
  ]
  "en" => array:20 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>"
    "titulo" => "Description and study of risk factors for the diagnostic delay of paediatric inflammatory bowel disease"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "247"
        "paginaFinal" => "254"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "J&#46;V&#46; Arcos-Machancoses, E&#46; Donat-Aliaga, B&#46; Polo-Miquel, E&#46; Masip-Sim&#243;, C&#46; Ribes-Koninckx, A&#46; Pereda-P&#233;rez"
        "autores" => array:6 [
          0 => array:2 [
            "nombre" => "J&#46;V&#46;"
            "apellidos" => "Arcos-Machancoses"
          ]
          1 => array:2 [
            "nombre" => "E&#46;"
            "apellidos" => "Donat-Aliaga"
          ]
          2 => array:2 [
            "nombre" => "B&#46;"
            "apellidos" => "Polo-Miquel"
          ]
          3 => array:2 [
            "nombre" => "E&#46;"
            "apellidos" => "Masip-Sim&#243;"
          ]
          4 => array:2 [
            "nombre" => "C&#46;"
            "apellidos" => "Ribes-Koninckx"
          ]
          5 => array:4 [
            "nombre" => "A&#46;"
            "apellidos" => "Pereda-P&#233;rez"
            "email" => array:1 [
              0 => "aperedap&#64;outlook&#46;com"
            ]
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:1 [
          0 => array:2 [
            "entidad" => "Unidad de Gastroenterolog&#237;a y Hepatolog&#237;a Pedi&#225;trica&#44; Hospital Universitario y Polit&#233;cnico La Fe&#44; Valencia&#44; Spain"
            "identificador" => "aff0005"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Retraso diagn&#243;stico en la enfermedad inflamatoria intestinal pedi&#225;trica&#46; Descripci&#243;n y estudio de los factores de riesgo"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1739
            "Ancho" => 1624
            "Tamanyo" => 132840
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Time elapsed until diagnosis by type of disease&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The onset of inflammatory bowel disease &#40;IBD&#41; usually occurs at around 20&#8211;30 years of age&#44; and is therefore considered a young adult disease&#46; However&#44; there is a subset of patients in whom onset occurs during childhood that&#44; depending on the published series&#44; amounts to 20&#8211;25&#37; of the total&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">In the past 20 years there has been an increase in the incidence of Crohn&#39;s disease &#40;CD&#41;&#44; while the number of ulcerative colitis &#40;UC&#41; diagnoses has remained stable or declined&#46; This phenomenon seems to apply to childhood cases as well&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">2</span></a> The diagnosis of IBD&#44; especially in this age group&#44; may be a considerable challenge due to the symptom overlap with functional bowel disorders and its variable clinical expression&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">It has been described that isolated ileal involvement in CD and consumption of anti-inflammatory agents and male sex in UC are risk factors for diagnostic delay &#40;DD&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">3</span></a> There is little evidence on the patient characteristics that contribute to a longer DD in children with IBD&#46; Some analyses based on European registries concluded that younger children and children with ileal CD experience the longest delays in diagnosis&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">IBD comprises a group of chronic and incurable diseases&#44; and there is evidence that delays in the initiation of treatment are associated with poorer responses to it and with a more severe course of disease&#46;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">5&#8211;8</span></a> Nearly 20&#37; of patients younger than 16 years diagnosed with CD have growth delay or a short stature&#46; The proportion in UC patients ranges from 5&#37; to 10&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">9</span></a> Children may catch up in weight and height with pharmacological and nutritional treatment&#44; but there is also evidence that a prolonged DD influences the final height of children with CD and facilitates the proximal extension of UC&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">10</span></a> Furthermore&#44; the diagnosis of IBD in a child or adolescent has a negative impact not only on physical aspects&#44; but also has a negative psychological&#44; familial and social impact&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">11</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">For the above reasons&#44; early diagnosis is considered a crucial element in the appropriate management of paediatric IBD&#46; Our aim was to study the duration of DD in patients in our setting in order to describe its main stages&#44; identify the main factors at play&#44; and propose corrective measures&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Patients and methods</span><p id="par0030" class="elsevierStylePara elsevierViewall">We conducted a retrospective study with the main objective of describing DD in paediatric IBD in our setting&#46; We set out to determine the time elapsed between the main care milestones&#58; T1&#44; time elapsed between the onset of symptoms and the first medical visit&#59; T2&#44; time elapsed between referral to the hospital and the first appointment with a specialist in paediatric gastroenterology&#59; T3&#44; time elapsed between the first hospital visit and the first digestive endoscopy&#59; and T4&#44; time elapsed between the first medical visit and the explicit documentation of the diagnosis in the medical records based on the clinical presentation&#44; laboratory data&#44; digestive endoscopy and histopathology&#46; We defined DD as equivalent to T4 and considered that DD was relevant for T4 values above the 75th percentile of each diagnostic group &#40;UC&#44; CD&#44; and unspecified IBD &#91;IBD-U&#93;&#41;&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The secondary objectives were to identify the work setting and degree of specialisation of the first doctor seen by the patient and of the doctor that made the referral to the specialist&#44; as well as the risk factors for having a relevant DD&#46; To this end&#44; we collected data pertaining to the clinical presentation&#44; use of diagnostic tools&#44; and extent of disease at the time of diagnosis according to the new Paris classification&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">12</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Any enthesitis and arthritis suspected to be an extraintestinal manifestation of IBD was confirmed by a paediatric rheumatologist&#46; The severity of disease flares was evaluated by means of the Paediatric Ulcerative Colitis Activity Index &#40;PUCAI&#41;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">13</span></a> and the Paediatric Crohn&#39;s Disease Activity Index &#40;PCDAI&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">14</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">We identified patients younger than 18 years diagnosed with IBD from the database of the clinical documentation department of our hospital&#46; The main sources of data were the paper medical records&#44; supplemented by electronic record files in both our hospital&#39;s database&#44; set up in 2010&#44; and the primary care &#40;PC&#41; system database&#44; which allowed for a better description of the time preceding the first contact at the hospital&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">We entered the data in a database created specifically for the purpose &#40;Microsoft Access 2010&#41;&#46; The statistical analysis was performed with the SPSS 19&#46;0 software&#46; Qualitative data were expressed as frequencies and percentages&#46; The Kolmogorov&#8211;Smirnov test revealed a non-normal distribution of the quantitative variables under study&#44; so we summarised these data using the median and the 95&#37; confidence interval &#40;CI&#41;&#44; the interquartile range &#40;IQR&#41; and the minimum and maximum values&#46; We used the <span class="elsevierStyleItalic">&#967;</span><span class="elsevierStyleSup">2</span> test to analyse the association between qualitative variables and the Mann&#8211;Whitney <span class="elsevierStyleItalic">U</span> nonparametric test to compare quantitative data&#44; with the main purpose of finding the differences between the CD and UC subgroups&#46; We used the Bonferroni post hoc test for the multiple univariate ANOVA in our assessment of risk factors&#46; The distribution of T4 for the whole sample and for CD and UC patients separately had a skewed shape with a marked right tail&#44; which we modified by logarithmic transformation&#46; This allowed for the use of multiple linear regression methods in our search for factors contributing to DD&#46; The Kaplan&#8211;Meier analysis of the main variable is shown in <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#44; and the differences in elapsed time by type of IBD were assessed by means of the Mantel&#8211;Cox test &#40;log rank&#41;&#44; based on the <span class="elsevierStyleItalic">&#967;</span><span class="elsevierStyleSup">2</span> for equivalence of the survival distributions&#46; We set the level of statistical significance at <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;05&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0055" class="elsevierStylePara elsevierViewall">We found data for 53 patients between January 2000 and January 2012&#46; The cohort included 31 children with CD &#40;58&#46;5&#37;&#41;&#44; 19 with a final diagnosis of UC &#40;35&#46;8&#37;&#41; and 6 with IBD-U at the beginning of the inclusion period&#44; 3 of which were later diagnosed as UC during the follow-up and included in the UC group for the statistical analysis&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">The median age at diagnosis was 10&#46;75 years for CD&#44; 7&#46;75 years for UC&#44; and 8&#46;83 years for IBD-U&#46; We found a significantly higher percentage of male patients among CD cases &#40;83&#46;9&#37;&#41; compared to UC cases &#40;47&#46;4&#37;&#41; and found no differences in the home setting of the children &#40;rural vs urban&#41; or the prevalence of smoking at the home&#46; We did find that family histories of IBD were more common in UC patients than in CD patients &#40;26&#46;3&#37; vs 13&#46;3&#37;&#41;&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> summarises the symptoms at the onset of disease&#46; We must note that all patients had intestinal symptoms at diagnosis &#40;diarrhoea&#44; rectal bleeding or abdominal pain&#41;&#44; while extraintestinal manifestations were present in seven &#40;13&#46;2&#37;&#41;&#58; one patient with CU had erythema nodosum and another sclerosing cholangitis&#44; and five CD patients had arthritis&#47;enthesitis&#46; Constitutional symptoms such as weight loss&#44; fever and asthenia occurred more frequently in CD versus UC patients &#40;a difference that did not reach statistical significance&#41; and always in combination with digestive symptoms&#46; Only one patient with CD had isolated abdominal pain at the onset&#46; None of the children exhibited growth delay as the sole clinical manifestation at the onset&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">Seven cases were diagnosed before 5 years of age &#40;13&#46;2&#37;&#58; 4 with UC&#44; 2 with CD and 1 with IBD-U&#41; and all had onset with diarrhoea and abdominal pain&#46; When we stratified by age and analysed CD and UC separately we did not find significant differences in the initial symptoms&#44; although we observed a trend towards greater growth delay in children younger than 5 years&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">A colonoscopy was performed in every child in the cohort&#46; Due to technical limitations&#44; ileoscopies were performed satisfactorily in only 58&#46;1&#37; of CD patients&#46; None of the UC patients were considered for an upper GI endoscopy&#44; but a barium enema was performed in 36&#46;8&#37; of these patients at some point during their follow-up&#44; mostly due to an incomplete colonoscopy during the diagnostic process&#46; Magnetic resonance enterography was performed in 74&#46;2&#37; of CD patients&#44; especially in cases diagnosed in later years&#44; compared to 15&#46;8&#37; of UC patients&#46; Examination by capsule endoscopy was also more frequent in CD patients &#40;61&#46;3&#37;&#41;&#46; Only one patient that was finally diagnosed with UC underwent this procedure while still diagnosed with IBD-U&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows the distribution of UC and CD cases into the subgroups defined by the new Paris classification&#46; We were able to retrieve information on the extent of the disease for every patient with CD and UC&#46; We only lacked sufficient data to determine the severity of the first flare of the disease for two patients with UC that had been transferred from other hospitals&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">The number of visits made to the emergency department for clinical features attributable to IBD before diagnosis was low&#44; with a median of one visit for both CD and UC patients&#46; However&#44; 71&#46;4&#37; of the children were seen at least once in hospital emergency departments&#44; which resulted in 26&#37; of the referrals to the paediatric gastroenterology department&#46; Most referrals to the specialist were made from PC &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46; A gastroenterologist was the first doctor to see the patient in only one case&#46; While only 6&#37; of the patients were first seen by hospital paediatricians that did not specialise in gastroenterology&#44; these providers made the referral to the specialist in 22&#37; of the cases&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">Children who first sought care for their IBD symptoms in a PC setting experienced a longer DD than children who were initially assessed in a hospital emergency department&#44; with a median DD of 26 weeks &#40;IQR&#44; 11&#46;5&#8211;78&#41; versus 3 weeks &#40;IQR&#44; 1&#46;5&#8211;5&#41;&#46; However&#44; patients first seen in PC had delayed growth less frequently &#40;37&#46;5&#37; vs 69&#37;&#41;&#44; clinical features that were less specific&#44; and higher T2 values&#46; Thus&#44; if the patient was referred from PC&#44; the median time to referral was 2 weeks&#44; with an IQR of 1&#8211;4 weeks and a maximum of 10 weeks&#44; while referrals from the emergency department &#40;in all cases&#44; from our hospital&#41; never took longer than one week&#46; The distribution by age was similar in both groups &#40;RIQ of 7&#46;5&#8211;11&#46;7 years for PC and 8&#46;6&#8211;11&#46;4 years for the emergency department&#41;&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">The median time elapsed from the initial symptoms of IBD to the first visit to a doctor was 2 weeks &#40;95&#37; CI&#44; 1&#8211;2&#59; RIQ&#44; 1&#8211;3 weeks&#41;&#46; There was a median delay of 12 weeks between this first visit and the definitive diagnosis &#40;95&#37; CI&#44; 5&#8211;24 weeks&#59; RIQ&#44; 3&#8211;48 weeks&#41;&#46; The rest of the time intervals is presented in <a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#46; We did not find differences in any of the 4 time intervals studied when we analysed UC and CD separately&#46; There was no difference in DD between UC and CD patients when we applied survival analysis methods &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; We considered DD relevant if it exceeded 38 weeks in UC patients and starting at 51 weeks in CD patients&#46; Delays longer than one year occurred in 26&#46;3&#37; of UC patients and 25&#46;8&#37; of CD patients&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">The univariate analysis &#40;<a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a>&#41; revealed that age below 5 years was the only factor with a significant influence on DD in IBD-U&#46; At any rate&#44; the significance of this finding disappeared once the Bonferroni corrections were applied&#46; The multiple linear regression analysis did not identify any variables significantly associated with the duration of DD nor a satisfactory model for its prediction&#46; We also found no associations when we used the median T4 as a measure of the DD&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0105" class="elsevierStylePara elsevierViewall">We present a series of 53 patients with characteristics similar to those described in the literature for IBD-U&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">15</span></a> We found a proportion of male CD patients &#40;83&#46;9&#37;&#41; that was above what was previously described in the literature&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">16</span></a> Our results corroborate that abdominal pain is the typical presentation in paediatric patients&#44; unlike in adults&#44; in whom isolated diarrhoea is more frequent&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">16</span></a> Growth delay&#44; reflected by a one- or two-standard deviation drop relative to the previous stature&#44; was observed in 45&#46;2&#37; of CD patients before the IBD diagnosis&#46; The cause of growth failure is multifactorial and is closely associated with the disease&#39;s inflammatory activity&#44; which would explain the higher probability of finding it in cases with longer DDs&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">17</span></a> This is supported by the greater frequency of growth failure found in our population among children diagnosed before 5 years of age&#46; Considering the problems that derive from this complication&#44; including its psychosocial impact&#44; the possibility of specific hormonal treatment should be evaluated by a paediatric endocrinologist in adherence with the pertinent recommendations&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">18</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">A positive family history of IBD was found more frequently in UC patients than in CD patients&#44; and only one of the nine patients with affected first-degree relatives had a relevant DD&#44; which suggests that a positive family history may increase the degree of suspicion for IBD&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">The trend towards greater growth delay in cases with relevant DDs suggests that early diagnosis is crucial in children with IBD&#46; Growth delay affected 50&#37; of children with CD who were diagnosed after more than 6 months&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Endoscopy is the gold standard for the initial examination of patients with suspected IBD according to the protocol established by the European Society for Paediatric Gastroenterology&#44; Hepatology and Nutrition&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">19</span></a> The Porto criteria established that in addition to an ileonoscopy&#44; an upper gastrointestinal endoscopy &#40;UGIE&#41; and multiple biopsies should be performed to determine the extent of the disease more precisely and to minimise the possibility of a IBD-U diagnosis&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">20</span></a> Despite having performed an UGIE in only 5 patients&#44; our proportion of IBD-U is not similar to the figures reported in the literature&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">21</span></a> The main limitation of our study was the incomplete diagnosis according to the Porto criteria&#44; which may have led to a bias in the subclassification of the extent and behaviour of the disease&#44; and therefore in the assessment of risk factors for DD&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Previous studies have shown a high variation in the duration of DD&#44; which is usually longer than the delay found in our study&#46; The EPIMAD registry reports time elapsed between onset of symptoms and diagnosis of 2 months for UC and 4 months for CD in some regions in France&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">2</span></a> The DD was greater than 4 months in a prospective population study in Norway&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">22</span></a> A study of British children with IBD reported mean DDs of 4 &#40;UC&#41; and 5 months &#40;CD&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">23</span></a> The data of the national Italian registry of paediatric IBD show DDs of 6 months for UC and 10 months for CD&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">24</span></a> The CEDATA registry in Germany and Austria&#44; which collected retrospective and prospective data on 2604 children from before 1995 through August 2009&#44; found a decreasing trend in DD in recent years&#44; with the median DD declining to 2&#46;5 months between 2008 and 2009&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">4</span></a> This epidemiological study concluded that DD was greater in younger patients and in patients with small bowel CD&#46; These data are consistent with those of other studies that were not specifically designed to assess DD&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">25</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">The median DD in children with IBD is 12 weeks&#46; The mean DD&#44; on the other hand&#44; is 31&#46;6 weeks&#44; which shows the influence of extremely large values in the distribution&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">In CD patients&#44; stricturing or penetrating behaviour and large bowel involvement are associated to shorter DDs&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">4</span></a> While our data also showed a trend towards a shorter DD in those conditions&#44; the finding was not statistically significant&#46; Our series included 51&#46;6&#37; of purely inflammatory forms of the disease&#44; compared to the 80&#8211;90&#37; reported in other studies&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">26</span></a> The greater proportion of more severe forms of the disease may have resulted in more noticeable clinical features and a shorter DD&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Another factor that may have contributed to the shorter DD in our study is that the median age of our patients was slightly higher than the median ages in other series&#44;<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">1&#44;4</span></a> which may lead to an earlier presumptive diagnosis&#46; Thus&#44; there was a trend towards a greater prevalence of relevant DD in children younger than 5 years compared to older children&#44; which was possibly due to a lesser degree of suspicion and less specific symptoms in the younger group&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">One possible explanation for the fact that 26&#37; of the patients referred to the specialist were referred from the hospital emergency department is that there would be a higher degree of suspicion in this setting because these cases would presumably be more severe&#44; or because the department has a closer association with the paediatric gastroenterology specialist&#46; On the other hand&#44; nearly three-quarters of the patients sought emergency care in a hospital at some point&#44; which presented the opportunity of referring this majority of patients to a specialist if it had not already been done by the healthcare centre&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">A multicentre study based on the CEDATA registry demonstrated that the referring centre had an effect on the duration of DD&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">4</span></a> This finding seems to support that DD is not only determined by the characteristics of the patient&#44; but also by factors related to the doctor providing care and the setting or conditions in which the doctor works&#46; In an adult case series&#44; the DD attributed to doctor-related factors was more pronounced in cases of CD than of UC<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">3</span></a>&#59; however&#44; our study showed a similar effect in both diseases&#46; A greater degree of suspicion of CD in our setting may account for this finding&#46; Thus&#44; the time elapsed before the first medical visit seems to be determined by the clinical and social characteristics of the patient&#44; and factors relating to health providers seem to be at play in subsequent time intervals&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">The information contained in the medical records sufficed to conduct this study&#44; although its retrospective design may have influenced the correct determination of the interval limits&#44; especially the beginning of T4&#44; that is&#44; the time elapsed between the first doctor&#8211;patient contact and the suspicion of IBD&#46; Furthermore&#44; the sample size has limited the possibility of identifying risk profiles for relevant DD&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">To conclude&#44; the duration of DD in our series was slightly shorter than those reported in previous studies&#44; which we attribute to our sample being more recent and to the likelihood of a greater knowledge of IBD in the PC and hospital emergency departments&#46; Nevertheless&#44; the fact that there were a large number of children with DDs exceeding one year shows that there is still room for improvement in the time intervals that depend on healthcare providers&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">A method similar to the one applied in a recent study of colorectal cancer in adults<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">27</span></a> could help identify missed chances for diagnosis&#46; A prospective multicentre observational study similar to the ongoing study of the Sociedad Espa&#241;ola de Gastroenterolog&#237;a&#44; Hepatolog&#237;a y Nutrici&#243;n Pedi&#225;trica &#40;Spanish Society of Paediatric Gastroenterology&#44; Hepatology and Nutrition&#41; could be the most suitable design to identify at-risk patients&#44; obtain a more accurate description of DD in a larger population&#44; and achieve our ultimate goal&#58; the implementation of corrective measures and improvement in disease outcomes&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conflicts of interest</span><p id="par0170" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:10 [
        0 => array:3 [
          "identificador" => "xres502751"
          "titulo" => "Abstract"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "abst0005"
              "titulo" => "Introduction"
            ]
            1 => array:2 [
              "identificador" => "abst0010"
              "titulo" => "Patients and methods"
            ]
            2 => array:2 [
              "identificador" => "abst0015"
              "titulo" => "Results"
            ]
            3 => array:2 [
              "identificador" => "abst0020"
              "titulo" => "Conclusions"
            ]
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec523910"
          "titulo" => "Keywords"
        ]
        2 => array:3 [
          "identificador" => "xres502752"
          "titulo" => "Resumen"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "abst0025"
              "titulo" => "Introducci&#243;n"
            ]
            1 => array:2 [
              "identificador" => "abst0030"
              "titulo" => "Pacientes y m&#233;todos"
            ]
            2 => array:2 [
              "identificador" => "abst0035"
              "titulo" => "Resultados"
            ]
            3 => array:2 [
              "identificador" => "abst0040"
              "titulo" => "Conclusiones"
            ]
          ]
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec523909"
          "titulo" => "Palabras clave"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        5 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Patients and methods"
        ]
        6 => array:2 [
          "identificador" => "sec0015"
          "titulo" => "Results"
        ]
        7 => array:2 [
          "identificador" => "sec0020"
          "titulo" => "Discussion"
        ]
        8 => array:2 [
          "identificador" => "sec0025"
          "titulo" => "Conflicts of interest"
        ]
        9 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2014-05-05"
    "fechaAceptado" => "2014-05-29"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec523910"
          "palabras" => array:3 [
            0 => "Diagnostic delay"
            1 => "Inflammatory bowel disease"
            2 => "Primary care"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec523909"
          "palabras" => array:3 [
            0 => "Retraso diagn&#243;stico"
            1 => "Enfermedad inflamatoria intestinal"
            2 => "Atenci&#243;n primaria"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Diagnostic delay of inflammatory bowel disease in children might be responsible for complications and a poor response to treatment&#46; The study of diagnostic delay and its determining factors may help implement corrective measures and improve the prognosis of the disease&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Patients and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A retrospective study of the information collected from primary care medical records and that from the paediatric gastroenterology service at a tertiary hospital between 2000 and 2012 was carried out in 53 patients&#58; 31 with Crohn&#39;s disease&#44; 19 with ulcerative colitis&#44; and 3 with unclassified paediatric inflammatory bowel disease&#46; The main response variable was the interval from the first physician&#8211;patient contact to diagnosis&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The median time to diagnosis was 12 weeks &#40;interquartile range 5&#8211;24&#41;&#46; However for 26&#46;3&#37; of the ulcerative colitis cases and 25&#46;8&#37; of the Crohn&#39;s disease cases&#44; the interval was longer than 1 year&#46; There was a more marked delay trend in Crohn&#39;s disease cases&#44; but it was not statistically significant&#46; None of the evaluated risk factors were associated with a relevant diagnostic delay&#44; although it tended to be longer in younger children&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Whereas the median delay for paediatric inflammatory bowel disease seems to be acceptable&#44; the diagnostic time spans are considerable for a large proportion of children with heterogeneous clinical characteristics&#46; Further research into lost diagnostic opportunities needs to be carried out&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Introduction"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Patients and methods"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusions"
          ]
        ]
      ]
      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">El retraso diagn&#243;stico &#40;RD&#41; de la enfermedad inflamatoria intestinal pedi&#225;trica &#40;EII-P&#41; puede conllevar la aparici&#243;n de complicaciones y una menor respuesta al tratamiento&#46; Estudiar el RD y los factores que lo condicionan ayudar&#237;a a implementar medidas correctoras y mejorar la evoluci&#243;n de la enfermedad&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Pacientes y m&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Un total de 53 casos &#40;31 de enfermedad de Crohn &#91;EC&#93;&#44; 19 de colitis ulcerosa &#91;CU&#93; y 3 EII-P no clasificadas&#41; entre 2000 y 2012 se evaluaron de forma retrospectiva a trav&#233;s de la informaci&#243;n recogida en las historias cl&#237;nicas de atenci&#243;n primaria y las de un Servicio de Gastroenterolog&#237;a infantil de un hospital terciario&#46; La variable respuesta principal fue el tiempo entre el primer contacto m&#233;dico-paciente y el diagn&#243;stico&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">El tiempo mediano de RD fue de 12 semanas &#40;rango intercuart&#237;lico 5-24&#41;&#46; Sin embargo&#44; un 26&#44;3&#37; de las CU y un 25&#44;8&#37; de las EC presentaron un RD superior a un a&#241;o&#46; Ninguno de los factores de riesgo estudiados se asoci&#243; significativamente a un RD relevante pero los ni&#241;os de menor edad presentaron una tendencia a un mayor RD&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Aunque el RD mediano de la EII-P parece aceptable&#44; existe una proporci&#243;n importante de ni&#241;os con unas caracter&#237;sticas cl&#237;nicas heterog&#233;neas y unos tiempos diagn&#243;sticos considerables&#46; Se deber&#237;a profundizar en el an&#225;lisis de las oportunidades perdidas de diagn&#243;stico&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Introducci&#243;n"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Pacientes y m&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusiones"
          ]
        ]
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Please cite this article as&#58; Arcos-Machancoses JV&#44; Donat-Aliaga E&#44; Polo-Miquel B&#44; Masip-Sim&#243; E&#44; Ribes-Koninckx C&#44; Pereda-P&#233;rez A&#46; Retraso diagn&#243;stico en la enfermedad inflamatoria intestinal pedi&#225;trica&#46; Descripci&#243;n y estudio de los factores de riesgo&#46; An Pediatr &#40;Barc&#41;&#46; 2015&#59;82&#58;247&#8211;254&#46;</p>"
      ]
    ]
    "multimedia" => array:6 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1739
            "Ancho" => 1624
            "Tamanyo" => 132840
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Time elapsed until diagnosis by type of disease&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:3 [
          "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">CD&#58; Crohn&#39;s disease&#59; UC&#58; ulcerative colitis&#46;</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">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Ulcerative colitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Crohn&#39;s disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Undetermined colitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">P</span>-value of the difference between UC and CD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Frequency</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">19&#47;53 &#40;35&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">31&#47;53 &#40;58&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#47;53 &#40;5&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Age at diagnosis in years</span><span class="elsevierStyleItalic">&#40;median&#44; IQR&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#46;75 &#40;5&#46;25&#8211;11&#46;71&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#46;75 &#40;9&#46;08&#8211;12&#46;92&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#46;83 &#40;3&#46;08&#8211;12&#46;08&#41;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;048&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Male sex</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#47;19 &#40;47&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26&#47;31 &#40;83&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#47;3 &#40;66&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;006&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Rural home setting</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#47;19 &#40;10&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#47;29 &#40;3&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#47;3 &#40;66&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;322&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Family history</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#47;19 &#40;26&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#47;30 &#40;13&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#47;3 &#40;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;253&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" 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="5" align="left" valign="top"><span class="elsevierStyleItalic">Clinical manifestations</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Diarrhoea&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18&#47;19 &#40;94&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&#47;31 &#40;64&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#47;3 &#40;100&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;015&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Weight loss&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#47;19 &#40;52&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">19&#47;31 &#40;61&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#47;3 &#40;66&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;547&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Rectal bleeding&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17&#47;19 &#40;89&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14&#47;31 &#40;45&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#47;3 &#40;100&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;002&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Abdominal pain&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&#47;19 &#40;84&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30&#47;31 &#40;96&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#47;3 &#40;100&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;112&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Fever&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#47;19 &#40;15&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#47;31 &#40;22&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#47;3 &#40;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;560&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Asthenia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&#47;19 &#40;68&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22&#47;31 &#40;71&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#47;3 &#40;66&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;849&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Fistula&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#47;19 &#40;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#47;31 &#40;19&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#47;3 &#40;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;009&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Anal fissure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#47;19 &#40;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#47;31 &#40;6&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#47;3 &#40;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;103&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Extraintestinal manifestations during the course of the disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#47;19 &#40;10&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#47;31 &#40;16&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#47;3 &#40;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;579&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab802067.png"
              ]
            ]
          ]
          "notaPie" => array:1 [
            0 => array:3 [
              "identificador" => "tblfn0005"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Median &#40;maximum<span class="elsevierStyleHsp" style=""></span>&#8722;<span class="elsevierStyleHsp" style=""></span>minimum&#41;&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Demographic data and clinical manifestations at onset&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:1 [
          "tablatextoimagen" => array:2 [
            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  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Crohn&#39;s disease</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Age</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>A1a&#44; younger than 10 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&#47;31 &#40;41&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>A1b&#44; between 10 and 17 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18&#47;31 &#40;58&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>A2&#44; older than 17 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#47;31 &#40;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Extent</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>L1&#44; ileal or limited caecal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&#47;31 &#40;35&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>L2&#44; colonic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#47;31 &#40;12&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>L3&#44; ileocolonic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#47;31 &#40;32&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>L1<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>L4a&#44; upper disease proximal to ligament of Treitz&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#47;31 &#40;3&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>L1<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>L4b&#44; upper disease distal to ligament of Treitz and proximal to distal 1&#47;3 ileum&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#47;31 &#40;16&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Behaviour</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>B1&#44; inflammatory nonstricturing nonpenetrating&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&#47;31 &#40;51&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>B2&#44; stricturing&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#47;31 &#40;29&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>B2p&#44; stricturing with perianal involvement&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#47;31 &#40;6&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>B3&#44; penetrating&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#47;31 &#40;3&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>B3p&#44; penetrating with perianal involvement&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#47;31 &#40;6&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>B2B3&#44; stricturing-penetrating&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#47;31 &#40;9&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Growth</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>G0&#44; no evidence of growth delay&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17&#47;31 &#40;54&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>G1&#44; growth delay&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14&#47;31 &#40;45&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab802068.png"
              ]
            ]
            1 => 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  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Ulcerative colitis</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Extent</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>E1&#44; proctitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#47;19 &#40;5&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>E2&#44; left sided UC &#40;distal to splenic flexure&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#47;19 &#40;21&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>E3&#44; extensive colitis &#40;distal to hepatic flexure&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#47;19 &#40;5&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>E4&#44; pancolitis &#40;proximal to hepatic flexure&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&#47;19 &#40;68&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Severity</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>S0&#44; never severe&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&#47;17 &#40;64&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>S1&#44; ever severe&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#47;17 &#40;35&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab802066.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Severity and extent of disease at the time of diagnosis as defined by the Paris classification&#46;</p>"
        ]
      ]
      3 => array:7 [
        "identificador" => "tbl0015"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">First doctor that cared for patient</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Doctor that referred to specialist</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Ulcerative colitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Crohn&#39;s disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Ulcerative colitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Crohn&#39;s disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Primary care paediatrician</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&#47;19 &#40;57&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18&#47;31 &#40;58&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#47;19 &#40;31&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#47;31 &#40;32&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Emergency department</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#47;19 &#40;36&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#47;31 &#40;32&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#47;19 &#40;26&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#47;31 &#40;25&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" 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="5" align="left" valign="top"><span class="elsevierStyleItalic">Hospital paediatrician</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Not specialised in paediatric gastroenterology&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#47;19 &#40;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#47;31 &#40;9&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#47;19 &#40;26&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#47;31 &#40;19&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span> Specialised in paediatric gastroenterology&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#47;19 &#40;5&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#47;31 &#40;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#47;19 &#40;15&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#47;31 &#40;22&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab802069.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Doctors involved in the diagnosis&#46;</p>"
        ]
      ]
      4 => array:7 [
        "identificador" => "tbl0020"
        "etiqueta" => "Table 4"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">CD&#58; Crohn&#39;s disease&#59; UC&#58; ulcerative colitis&#46;</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">Time in completed weeks&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Time elapsed between onset of symptoms and first medical visit</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Time elapsed between referral to hospital and first hospital visit</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Time elapsed between first hospital visit and first endoscopy</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Time elapsed between first medical visit and diagnosis</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">CU&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">EC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">CU&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">EC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">CU&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">EC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">CU&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">EC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Cases&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Minimum&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">1&#37;ile&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">10&#37;ile&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">25&#37;ile&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">50&#37;ile &#40;95&#37; CI&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;1&#8211;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;2&#8211;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;0&#8211;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;5 &#40;0&#8211;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;2&#8211;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;1&#8211;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12 &#40;4&#8211;24&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12 &#40;3&#8211;32&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">75&#37;ile&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">51&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">90&#37;ile&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">113&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">116&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">103&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Maximum&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">152&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">208&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">152&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">208&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">P</span>-value&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " colspan="2" align="center" valign="top">&#46;110</td><td class="td" title="table-entry  " colspan="2" align="center" valign="top">&#46;243</td><td class="td" title="table-entry  " colspan="2" align="center" valign="top">&#46;068</td><td class="td" title="table-entry  " colspan="2" align="center" valign="top">&#46;877</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab802065.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Distribution of time to diagnosis for ulcerative colitis and Crohn&#39;s disease&#46;</p>"
        ]
      ]
      5 => array:7 [
        "identificador" => "tbl0025"
        "etiqueta" => "Table 5"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">CD&#58; Crohn&#39;s disease&#59; CI&#58; confidence interval&#59; OR&#58; odds ratio&#59; UC&#58; ulcerative colitis&#46;</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">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Diagnostic delay<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>75th percentile&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Diagnostic delay<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>75th percentile&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">P</span>-value&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Diagnostic delay OR<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>75th percentile &#40;95&#37; CI&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Weight loss&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&#47;38 &#40;52&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&#47;15 &#40;73&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;168&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;48 &#40;0&#46;67&#8211;9&#46;17&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Age less than 5 years at onset&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#47;38 &#40;5&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#47;15 &#40;33&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;015&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#46;00 &#40;1&#46;51&#8211;53&#46;54&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Family history&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#47;37 &#40;21&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#47;15 &#40;6&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;197&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;26 &#40;0&#46;03&#8211;2&#46;28&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Extraintestinal manifestations&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#47;38 &#40;15&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#47;15 &#40;6&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;377&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;38 &#40;0&#46;04&#8211;3&#46;47&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Stricturing or penetrating behaviour in CD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&#47;23 &#40;52&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#47;8 &#40;37&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;474&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;55 &#40;0&#46;11&#8211;2&#46;86&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">First medical visit after one or more months since onset of clinical symptoms of CD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18&#47;23 &#40;78&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#47;8 &#40;75&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;849&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;83 &#40;0&#46;13&#8211;5&#46;47&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Small bowel involvement in CD &#40;L1 or L1 &#43; L4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14&#47;23 &#40;60&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#47;8 &#40;37&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;253&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;39 &#40;0&#46;07&#8211;2&#46;03&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Ileal or ileocaecal involvement in CD &#40;L1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#47;23 &#40;43&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#47;8 &#40;12&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;115&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;19 &#40;0&#46;02&#8211;1&#46;77&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Presence of anal fistula in the first CD examination&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#47;23 &#40;26&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#47;8 &#40;37&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;540&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;70 &#40;0&#46;31&#8211;9&#46;37&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Growth delay in CD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#47;23 &#40;39&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#47;8 &#40;62&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;253&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;59 &#40;0&#46;49&#8211;13&#46;61&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">First medical visit after a month or more with clinical symptoms of UC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&#47;13 &#40;92&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#47;6 &#40;66&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;154&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;17 &#40;0&#46;01&#8211;2&#46;37&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Severe disease at onset of UC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#47;13 &#40;23&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#47;6 &#40;50&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;241&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;33 &#40;0&#46;43&#8211;26&#46;04&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab802064.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Univariate analysis&#46; Clinical features at diagnosis&#58; impact on diagnostic delay&#46;</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" => "Increasing incidence of paediatric inflammatory bowel disease in Ontario&#44; Canada&#58; evidence from health administrative data"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "E&#46;I&#46; Benchimol"
                            1 => "A&#46; Guttman"
                            2 => "A&#46;M&#46; Griffiths"
                            3 => "L&#46; Rabeneck"
                            4 => "D&#46;R&#46; Mack"
                            5 => "H&#46; Brill"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/gut.2009.188383"
                      "Revista" => array:6 [
                        "tituloSerie" => "Gut"
                        "fecha" => "2009"
                        "volumen" => "58"
                        "paginaInicial" => "1490"
                        "paginaFinal" => "1497"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19651626"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0145"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Incidence&#44; clinical presentation and location at diagnosis of pediatric inflammatory bowel disease&#58; a prospective population-based study in northern France &#40;1988&#8211;1999&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46; Auvin"
                            1 => "F&#46; Molinie"
                            2 => "C&#46; Gower-Rousseau"
                            3 => "F&#46; Brazier"
                            4 => "V&#46; Merle"
                            5 => "B&#46; Grandbastien"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Pediatr Gastroenterol Nutr"
                        "fecha" => "2005"
                        "volumen" => "41"
                        "paginaInicial" => "49"
                        "paginaFinal" => "55"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15990630"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0150"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Systematic evaluation of risk factors for diagnostic delay in inflammatory bowel disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46;R&#46; Vavricka"
                            1 => "S&#46;M&#46; Spigaglia"
                            2 => "G&#46; Rogler"
                            3 => "V&#46; Pittet"
                            4 => "P&#46; Michetti"
                            5 => "C&#46; Felley"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/ibd.21719"
                      "Revista" => array:6 [
                        "tituloSerie" => "Inflamm Bowel Dis"
                        "fecha" => "2012"
                        "volumen" => "18"
                        "paginaInicial" => "496"
                        "paginaFinal" => "505"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21509908"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0155"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Childhood onset inflammatory bowel disease&#58; predictors of delayed diagnosis from the CEDATA German-language pediatric inflammatory bowel disease registry"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Timmer"
                            1 => "R&#46; Behrens"
                            2 => "S&#46; Buderus"
                            3 => "A&#46; Findeisen"
                            4 => "A&#46; Hauer"
                            5 => "K&#46;M&#46; Keller"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jpeds.2010.09.014"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Pediatr"
                        "fecha" => "2011"
                        "volumen" => "158"
                        "paginaInicial" => "467"
                        "paginaFinal" => "473"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21051046"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0160"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Early inflammatory bowel disease&#58; different treatment response to specific or all medications&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "J&#46; Markowitz"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1159/000228574"
                      "Revista" => array:6 [
                        "tituloSerie" => "Dig Dis"
                        "fecha" => "2009"
                        "volumen" => "27"
                        "paginaInicial" => "358"
                        "paginaFinal" => "365"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19786765"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0165"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Are we giving azathioprine too late&#63; The case for early immunomodulation in inflammatory bowel disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "M&#46;J&#46; Etchevers"
                            1 => "M&#46; Aceituno"
                            2 => "M&#46; Sans"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "World J Gastroenterol"
                        "fecha" => "2008"
                        "volumen" => "14"
                        "paginaInicial" => "5512"
                        "paginaFinal" => "5518"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18810768"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0170"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effect of early immunomodulator use in moderate to severe pediatric Crohn disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46; Punati"
                            1 => "J&#46; Markowitz"
                            2 => "T&#46; Lerer"
                            3 => "J&#46; Hyams"
                            4 => "S&#46; Kugathasan"
                            5 => "A&#46; Griffiths"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/ibd.20412"
                      "Revista" => array:6 [
                        "tituloSerie" => "Inflamm Bowel Dis"
                        "fecha" => "2008"
                        "volumen" => "14"
                        "paginaInicial" => "949"
                        "paginaFinal" => "954"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18306311"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0175"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Presentation and disease course in early-compared to later-onset pediatric Crohn&#39;s disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "N&#46; Gupta"
                            1 => "A&#46;G&#46; Bostrom"
                            2 => "B&#46;S&#46; Kirschner"
                            3 => "S&#46;A&#46; Cohen"
                            4 => "O&#46; Abramson"
                            5 => "G&#46;D&#46; Ferry"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1572-0241.2008.02000.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Gastroenterol"
                        "fecha" => "2008"
                        "volumen" => "103"
                        "paginaInicial" => "2092"
                        "paginaFinal" => "2098"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18796101"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0180"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Current diagnosis&#44; management and morbidity in paediatric inflammatory bowel disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "C&#46; Spray"
                            1 => "G&#46;D&#46; Debelle"
                            2 => "M&#46;S&#46; Murphy"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Acta Paediatr"
                        "fecha" => "2001"
                        "volumen" => "90"
                        "paginaInicial" => "400"
                        "paginaFinal" => "405"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11332930"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0185"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical features affecting final adult height in patients with pediatric-onset Crohn&#39;s disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "A&#46; Sawczenko"
                            1 => "A&#46;B&#46; Ballinger"
                            2 => "M&#46;O&#46; Savage"
                            3 => "I&#46;R&#46; Sanderson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1542/peds.2005-2931"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatrics"
                        "fecha" => "2006"
                        "volumen" => "118"
                        "paginaInicial" => "124"
                        "paginaFinal" => "129"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16818557"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0190"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A meta-analytic review of the psychosocial adjustment of youth with inflammatory bowel disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "R&#46;N&#46; Greenley"
                            1 => "K&#46;A&#46; Hommel"
                            2 => "J&#46; Nebel"
                            3 => "T&#46; Raboin"
                            4 => "S&#46;H&#46; Li"
                            5 => "P&#46; Simpson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/jpepsy/jsp120"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Pediatr Psychol"
                        "fecha" => "2010"
                        "volumen" => "35"
                        "paginaInicial" => "857"
                        "paginaFinal" => "869"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20123705"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0195"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pediatric modification of the Montreal classification for inflammatory bowel disease&#58; the Paris classification"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Levine"
                            1 => "A&#46; Griffiths"
                            2 => "J&#46; Markowitz"
                            3 => "D&#46;C&#46; Wilson"
                            4 => "D&#46; Turner"
                            5 => "R&#46;K&#46; Russell"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/ibd.21493"
                      "Revista" => array:6 [
                        "tituloSerie" => "Inflamm Bowel Dis"
                        "fecha" => "2011"
                        "volumen" => "17"
                        "paginaInicial" => "1314"
                        "paginaFinal" => "1321"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21560194"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0200"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Development&#44; validation&#44; and evaluation of a pediatric ulcerative colitis activity index&#58; a prospective multicentre study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "D&#46; Turner"
                            1 => "A&#46;R&#46; Otley"
                            2 => "D&#46; Mack"
                            3 => "J&#46; Hyams"
                            4 => "J&#46; de Bruijne"
                            5 => "K&#46; Uusoue"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1053/j.gastro.2007.05.029"
                      "Revista" => array:6 [
                        "tituloSerie" => "Gastroenterology"
                        "fecha" => "2007"
                        "volumen" => "133"
                        "paginaInicial" => "423"
                        "paginaFinal" => "432"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17681163"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0205"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Development and validation of a pediatric Crohn&#39;s disease activity index"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;S&#46; Hyams"
                            1 => "G&#46;D&#46; Ferry"
                            2 => "F&#46;S&#46; Mandel"
                            3 => "J&#46;D&#46; Gryboski"
                            4 => "P&#46;M&#46; Kibort"
                            5 => "B&#46;S&#46; Kirschner"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Pediatr Gastroenterol Nutr"
                        "fecha" => "1991"
                        "volumen" => "12"
                        "paginaInicial" => "439"
                        "paginaFinal" => "447"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1678008"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0210"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Searching for new clues in inflammatory bowel disease&#58; tell tales from pediatric IBD natural history studies"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "S&#46; Kugathasan"
                            1 => "S&#46; Cohen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1053/j.gastro.2008.08.030"
                      "Revista" => array:6 [
                        "tituloSerie" => "Gastroenterology"
                        "fecha" => "2008"
                        "volumen" => "135"
                        "paginaInicial" => "1038"
                        "paginaFinal" => "1041"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18786536"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0215"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Presenting features of inflammatory bowel disease in Great Britain and Ireland"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "A&#46; Sawczenko"
                            1 => "B&#46;K&#46; Sandhu"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Dis Child"
                        "fecha" => "2003"
                        "volumen" => "88"
                        "paginaInicial" => "995"
                        "paginaFinal" => "1000"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14612366"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0220"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Mechanisms of growth impairment in pediatric Crohn&#39;s disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "T&#46;D&#46; Walters"
                            1 => "A&#46;M&#46; Griffiths"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1038/nrgastro.2009.124"
                      "Revista" => array:6 [
                        "tituloSerie" => "Nat Rev Gastroenterol Hepatol"
                        "fecha" => "2009"
                        "volumen" => "6"
                        "paginaInicial" => "513"
                        "paginaFinal" => "523"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19713986"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0225"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Guidelines for the management of growth failure in childhood inflammatory bowel disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "R&#46; Heuschkel"
                            1 => "C&#46; Salvestrini"
                            2 => "R&#46;M&#46; Beattie"
                            3 => "H&#46; Hildebrand"
                            4 => "T&#46; Walters"
                            5 => "A&#46; Griffiths"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/ibd.20378"
                      "Revista" => array:6 [
                        "tituloSerie" => "Inflamm Bowel Dis"
                        "fecha" => "2008"
                        "volumen" => "14"
                        "paginaInicial" => "839"
                        "paginaFinal" => "849"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18266237"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0230"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Inflammatory bowel disease in children and adolescents&#58; Recommendations for diagnosis &#8211; the Porto criteria"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;C&#46; Escher"
                            1 => "J&#46; Amil Dias"
                            2 => "K&#46; Bouchenek"
                            3 => "S&#46; Buderus"
                            4 => "M&#46; Bueno de Mesquita"
                            5 => "Y&#46; Bujanover"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Pediatr Gastroenterol Nutr"
                        "fecha" => "2005"
                        "volumen" => "41"
                        "paginaInicial" => "1"
                        "paginaFinal" => "7"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15990620"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0235"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Differentiating ulcerative colitis from Crohn disease in children and young adults&#58; Report of a working group of the North American Society for Pediatric Gastroenterology&#44; Hepatology&#44; and Nutrition and the Crohn&#39;s and Colitis Foundation of America"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Bousvaros"
                            1 => "D&#46;A&#46; Antonioli"
                            2 => "R&#46;B&#46; Colletti"
                            3 => "M&#46;C&#46; Dubinsky"
                            4 => "J&#46;N&#46; Glickman"
                            5 => "B&#46;D&#46; Gold"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/MPG.0b013e31805563f3"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Pediatr Gastroenterol Nutr"
                        "fecha" => "2007"
                        "volumen" => "44"
                        "paginaInicial" => "653"
                        "paginaFinal" => "674"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17460505"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0240"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Increasing incidence of pediatric inflammatory bowel disease in Spain &#40;1996&#8211;2009&#41;&#58; the SPIRIT Registry"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46; Mart&#237;n-de-Carpi"
                            1 => "A&#46; Rodr&#237;guez"
                            2 => "E&#46; Ramos"
                            3 => "S&#46; Jim&#233;nez"
                            4 => "M&#46;J&#46; Mart&#237;nez-G&#243;mez"
                            5 => "E&#46; Medina"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/ibd.22980"
                      "Revista" => array:6 [
                        "tituloSerie" => "Inflamm Bowel Dis"
                        "fecha" => "2013"
                        "volumen" => "19"
                        "paginaInicial" => "73"
                        "paginaFinal" => "80"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22535573"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0245"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Incidence of inflammatory bowel disease in children in southeastern Norway&#58; a prospective population-based study 1990&#8211;94"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "B&#46;S&#46; Bentsen"
                            1 => "B&#46; Moum"
                            2 => "A&#46; Ekbon"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Scand J Gastroenterol"
                        "fecha" => "2002"
                        "volumen" => "37"
                        "paginaInicial" => "540"
                        "paginaFinal" => "545"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12059055"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0250"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Natural history of paediatric inflammatory bowel disease over a 5-year follow-up&#58; a retrospective review of data from the register of paediatric inflammatory bowel diseases"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "E&#46;A&#46; Newby"
                            1 => "N&#46;M&#46; Croft"
                            2 => "M&#46; Green"
                            3 => "K&#46; Hassan"
                            4 => "R&#46;B&#46; Heuschkel"
                            5 => "H&#46; Jenkins"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/MPG.0b013e3181596efd"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Pediatr Gastroenterol Nutr"
                        "fecha" => "2008"
                        "volumen" => "46"
                        "paginaInicial" => "539"
                        "paginaFinal" => "545"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18493209"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0255"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Inflammatory bowel disease in children and adolescents in Italy&#58; data from the pediatric national IBD register &#40;1996&#8211;2003&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Castro"
                            1 => "B&#46; Papadatou"
                            2 => "M&#46; Baldassare"
                            3 => "F&#46; Balli"
                            4 => "A&#46; Barabino"
                            5 => "C&#46; Barbera"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/ibd.20470"
                      "Revista" => array:6 [
                        "tituloSerie" => "Inflamm Bowel Dis"
                        "fecha" => "2008"
                        "volumen" => "14"
                        "paginaInicial" => "1246"
                        "paginaFinal" => "1252"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18521916"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0260"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "NOD2&#47;CARD15 variants are associated with lower weight at diagnosis in children with Crohn&#39;s disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "G&#46; Tomer"
                            1 => "C&#46; Ceballos"
                            2 => "E&#46; Concepcion"
                            3 => "K&#46;J&#46; Benkov"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1572-0241.2003.08673.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Gastroenterol"
                        "fecha" => "2003"
                        "volumen" => "98"
                        "paginaInicial" => "2479"
                        "paginaFinal" => "2484"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14638352"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib0265"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Enfermedad inflamatoria intestinal &#40;I&#41;&#58; clasificaci&#243;n&#44; etiolog&#237;a y cl&#237;nica"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "E&#46; Medina"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "An Pediatr Contin"
                        "fecha" => "2013"
                        "volumen" => "11"
                        "paginaInicial" => "59"
                        "paginaFinal" => "67"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib0270"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Oportunidades perdidas en el diagn&#243;stico temprano del c&#225;ncer colorrectal sintom&#225;tico"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "M&#46; Dom&#237;nguez-Ayala"
                            1 => "J&#46; D&#237;ez-Vallejo"
                            2 => "A&#46; Comas-Fuentes"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Esp Enferm Dig"
                        "fecha" => "2012"
                        "volumen" => "104"
                        "paginaInicial" => "343"
                        "paginaFinal" => "349"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22849494"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/23412879/0000008200000004/v2_201505130138/S2341287915000435/v2_201505130138/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "26005"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Original Articles"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/23412879/0000008200000004/v2_201505130138/S2341287915000435/v2_201505130138/en/main.pdf?idApp=UINPBA00005H&text.app=https://www.analesdepediatria.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287915000435?idApp=UINPBA00005H"
]

Article information

ISSN: 23412879
Original language: English

DOI:10.1016/j.anpede.2015.03.004

The statistics are updated each day

Year/Month	Html	Pdf	Total

2024 October	37	21	58
2024 September	48	28	76
2024 August	60	60	120
2024 July	43	28	71
2024 June	54	24	78
2024 May	56	34	90
2024 April	42	38	80
2024 March	53	26	79
2024 February	106	36	142
2024 January	37	20	57
2023 December	55	24	79
2023 November	46	21	67
2023 October	50	23	73
2023 September	25	26	51
2023 August	32	16	48
2023 July	29	25	54
2023 June	40	49	89
2023 May	55	24	79
2023 April	24	17	41
2023 March	45	18	63
2023 February	38	18	56
2023 January	32	18	50
2022 December	66	22	88
2022 November	74	44	118
2022 October	42	25	67
2022 September	33	31	64
2022 August	40	57	97
2022 July	36	35	71
2022 June	41	21	62
2022 May	45	41	86
2022 April	31	24	55
2022 March	54	50	104
2022 February	33	25	58
2022 January	46	39	85
2021 December	39	39	78
2021 November	43	53	96
2021 October	84	56	140
2021 September	38	59	97
2021 August	68	51	119
2021 July	78	33	111
2021 June	47	38	85
2021 May	45	20	65
2021 April	97	45	142
2021 March	53	24	77
2021 February	47	18	65
2021 January	43	16	59
2020 December	36	57	93
2020 November	47	18	65
2020 October	26	17	43
2020 September	91	15	106
2020 August	84	16	100
2020 July	99	20	119
2020 June	38	22	60
2020 May	59	13	72
2020 April	50	15	65
2020 March	38	17	55
2020 February	35	20	55
2020 January	30	16	46
2019 December	65	16	81
2019 November	28	13	41
2019 October	14	11	25
2019 September	47	16	63
2019 August	64	14	78
2019 July	30	34	64
2019 June	24	14	38
2019 May	28	17	45
2019 April	51	18	69
2019 March	38	15	53
2019 February	31	14	45
2019 January	29	14	43
2018 December	28	22	50
2018 November	62	26	88
2018 October	129	17	146
2018 September	65	11	76
2018 August	2	0	2
2018 July	1	0	1
2018 June	2	0	2
2018 May	2	0	2
2018 April	22	0	22
2018 March	17	0	17
2018 February	10	0	10
2018 January	11	0	11
2017 December	11	0	11
2017 November	20	0	20
2017 October	17	0	17
2017 September	21	0	21
2017 August	11	0	11
2017 July	16	0	16
2017 June	22	8	30
2017 May	24	12	36
2017 April	16	6	22
2017 March	10	0	10
2017 February	12	3	15
2017 January	7	4	11
2016 December	26	8	34
2016 November	28	4	32
2016 October	38	4	42
2016 September	35	4	39
2016 August	32	2	34
2016 July	14	0	14
2016 March	1	0	1
2016 February	1	0	1
2015 December	6	11	17
2015 November	2	17	19
2015 October	15	21	36
2015 September	1	11	12
2015 August	2	11	13

Show all

Indexed in:

Follow us:

Subscribe:

Statistics

Indexed in:

Follow us:

Subscribe:

Statistics

Subscribe to our newsletter