When is a medical emergency really an emergency? Not during key BostonRed Sox games, report investigators from Children's Hospital Boston ina letter published in the October issue of Annals of EmergencyMedicine. Although previous studies have found a decline in health-careuse during major sporting events, the Children's researchers are thefirst to quantify the magnitude of the events -- using televisionNielsen ratings -- showing that the bigger or more suspenseful theevent, the quieter the emergency department.
Borrowing data from a real-time disease surveillance systemdeveloped at Children's, the researchers tracked hourly visit rates atsix Boston-area emergency departments during the each of the 2004American League Championship Series (ALCS) and World Series games. Theyplotted these rates against television viewership as indicated by localNielsen ratings.
During the lowest-rated games -- ALCS games 3 and 4, when theRed Sox were losing and facing probable elimination -- visits to theemergency room were about 15 percent above the volume expected, afteradjusting for time of day, day of week, and seasonal factors like fluthat can cause spikes in visit rates.
But then, the Red Sox won game 4. During game 5, Nielsenratings surged and ER visits dipped about 5 percent below normalvolume. During the highest-rated games -- the ALCS final game 7 and theWorld Series final game 4 -- fully 55-60 percent of Boston-areahouseholds tuned in and emergency-department visits dipped about 15percent below the expected volume.
Gripped by Red Sox fever during the 2004 postseason, thestudy's key researchers, Drs. John Brownstein and Ben Reis ofChildren's programs in Informatics and Emergency Medicine decided totap into the emergency department's Automated EpidemiologicalGeotemporal Integrated Surveillance system, or AEGIS, after the WorldSeries concluded. AEGIS, a disease-monitoring system that has beenexpanded for use by the Massachusetts Department of Public Health,analyzes patient data anonymously and compares it with data fromprevious medical visits, flagging abnormal disease clusters or symptompatterns.
After a week of late nights crunching and plotting data for thehours in question, Brownstein and Reis, also affiliated with HarvardMedical School, were able to show an inverse relationship between RedSox viewership and emergency-department visits that held up underrigorous statistical tests.
"The public health finding here is people use discretion indeciding when show up in the emergency department," says senior studyauthor Dr. Kenneth Mandl, an attending physician in Children'sDepartment of Emergency Medicine and a faculty member of the Children'sHospital Informatics Program at the Harvard-MIT Division of HealthSciences and Technology.
A previous study documented an increase in driving fatalitieson Super Bowl Sunday. However, Brownstein and Reis looked at emergencydepartment results only during the hours of the games themselves, notafterward when drunken fans might be driving. It also examined allcategories of visits, including routine health visits.
The hospitals analyzed were Children's, Beth Israel DeaconessMedical Center, Massachusetts General Hospital Cambridge Hospital,Somerville Hospital, and Whidden Memorial Hospital (serving thecommunities of Everett, Revere, Chelsea, Winthrop, and Malden).
Founded in 1869 as a 20-bed hospital for children, Children'sHospital Boston today is the nation's leading pediatric medical center,the largest provider of health care to Massachusetts children, and theprimary pediatric teaching hospital of Harvard Medical School. Inaddition to 347 pediatric and adolescent inpatient beds andcomprehensive outpatient programs, Children's houses the world'slargest research enterprise based at a pediatric medical center, whereits discoveries benefit both children and adults. More than 500scientists, including eight members of the National Academy ofSciences, nine members of the Institute of Medicine and 10 members ofthe Howard Hughes Medical Institute comprise Children's researchcommunity. For more information about the hospital visit: http://www.childrenshospital.org.
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