Circadian pattern of intubation rates in ED patients with congestive heart failure☆
Received 12 March 2008; received in revised form 26 October 2008; accepted 26 October 2008. published online 26 October 2009.
Abstract
Purpose
A previous study showed that pulmonary edema patients presenting between noon and 4 pm have the highest rates of myocardial infarction and death. We hypothesized that the highest intubation rates would also occur at these times.
Basic Procedures
We performed a retrospective cohort study of consecutive patients seen by emergency department physicians in 15 hospital emergency departments (1996-2003).
Main Findings
Of 3.6 million visits in the database, 39,795 (1.1%) patients had congestive heart failure. We found statistically significant circadian variations in intubation rates. Patients arriving between midnight and 4 am had the highest intubation rates (4.1%), and those arriving between noon and 4 pm had the lowest (1.2%) (difference, 2.9%; 95% confidence interval, 2.4%-3.4%; P < .0001).
Conclusion
We found significant circadian variation in intubation rates, with a marked increase around midnight. Pathological mechanisms causing patients with congestive heart failure to require intubation may differ from those resulting in myocardial infarction or death.
Morristown Memorial Hospital Residency in Emergency Medicine, Morristown, NJ 07962, USA
Corresponding author. Department of Emergency Medicine, Morristown Memorial Hospital, Morristown, NJ 07962, USA. Tel.: +1 973 971 8919; fax: +1 973 290 7202.
☆ The Emergency Medicine Associates Research Foundation provided us with the data and computer support.
ABSTRACT