Article, Emergency Medicine

Answering the myth: use of emergency services on Friday the 13th

Unlabelled imageAmerican Journal of Emergency Medicine (2012) 30, 886-889

Original Contribution

Answering the myth: use of emergency services on Friday the 13th?

Bruce M. Lo MD a,?, Catherine M. Visintainer MD a,

Heidi A. Best MD a, Hind A. Beydoun PhD, MPH b

aDepartment of Emergency Medicine, Eastern Virginia Medical School, Norfolk, VA 23507, USA

bGraduate Program in Public Health, Eastern Virginia Medical School, Norfolk, VA 23507, USA

Received 2 March 2011; revised 10 June 2011; accepted 15 June 2011

Abstract

Objective: The aim of the study was to evaluate the risk of Friday the 13th on Hospital admission rates and emergency department (ED) visits.

Methods: This was a retrospective chart review of all ED visits on Friday the 13th from November 13, 2002, to December 13, 2009, from 6 hospital-based EDs. Thirteen unlikely conditions were evaluated as well as total ED volumes. As a control, the Friday before and after and the month before and after were used. ?2 Analysis and Wilcoxon rank sum tests were used for each variable, as appropriate.

Results: A total of 49 094 patient encounters were evaluated. Average ED visits for Friday the 13th were not increased compared with the Friday before and after and the month before. However, compared with the month after, there were fewer ED visits on Friday the 13th (150.1 vs 134.7, P =

.011). Of the 13 categories evaluated, only penetrating trauma was noted to have an increase risk associated with Friday the 13th (odds ratio, 1.65; 95% confidence interval, 1.04-2.61). No other category was noted to have an increase risk on Friday the 13th compared with the control dates.

Conclusions: Although the fear of Friday the 13th may exist, there is no worry that an increase in volume occurs on Friday the 13th compared with the other days studies. Of 13 different conditions evaluated, only penetrating traumas were seen more often on Friday the 13th. For those providers who work in the ED, working on Friday the 13th should not be any different than any other day.

(C) 2012

Introduction

Superstitious beliefs are common throughout the medical profession and have been subject to inquiry [1]. For example, the effect of the full moon is one of the most extensively studied superstitions affecting the medical field. Numerous studies have been published on the effects of the full moon on various medical conditions such as hospital

? Funding: None.

* Corresponding author. Tel.: +1 757 388 3397; fax: +1 757 388 2885.

E-mail address: [email protected] (B.M. Lo).

admissions [2], Cerebrovascular accidents [3], acute myo- cardial infarction [4], seizures [5,6], trauma [7], Motor vehicle collisions (MVC) [8,9], animal bites [10,11], and psychiatric visits [12].

Both Friday and the number 13 have unlucky folklore associated with them. The combination is purported to be particularly unlucky, with references that go back as far as ancient times. As a result, it has been reported that a significant number of people in the United States will alter their daily life because of this superstition. Our objective was to look at emergency department (ED) use on Friday the 13th.

0735-6757/$ – see front matter (C) 2012 doi:10.1016/j.ajem.2011.06.008

Methods

To see if Friday the 13th is as unlucky as it is thought to be, a retrospective chart review was performed on data from 6 different hospital-based EDs. Patients presenting to the ED on 13 Friday the 13th from November 13, 2002, to December 13, 2009, were included. As a control, data were abstracted from the Friday before and the Friday after as well as the month before and the month after for each Friday the 13th. Thirteen unlucky categories were evalu- ated: female patients coming to the ED, medical admissions through the ED, acute coronary syndrome, acute cerebellar ischemia or transient ischemic attacks, seizure, nontrau- matic surgical admissions, animal bites, MVCs, female MVC, penetrating traumas, admissions for traumatic injuries, psychiatric evaluations, and female psychiatric evaluations. total ED visits were also compared. All data were abstracted from the electronic medical record. For dates at a hospital that preceded the use of electronic medical record, those visits were not analyzed because of the inaccessibility of those records.

Statistical analysis

Variables from Friday the 13th were compared with the average of the other 4 control dates. Data were entered in a uniform manner by the investigators reviewing each individual record on a Microsoft Excel spreadsheet (Micro- soft Corp, Redmond, WA). If the encounter crossed more than 1 category, each of the categories would receive credit for that particular encounter.

?2 Analysis was used for categorical variable comparison. Wilcoxon rank sum tests were used to compare the number of ED visits. Data were analyzed using Statistical Analysis Software v. 9.2 (SAS Institute, Inc, Cary, NC).

Results

A total of 49 094 records were reviewed, including 9831 ED visits on Friday the 13th and 39 263 visits on the other 4 dates combined. The average daily volume per ED is seen in Table 1. Of the 4 different dates compared, no difference was

Table 1 Average daily volume of patients per ED on Friday the 13th compared with the Friday before, Friday after, month before, and month after (SD = Standard Deviation)

Average volume (SD)

P

Friday the 13th

135

(36.2)

Friday before

134

(33.4)

.94

Friday after

135

(33.6)

.99

Month before

145

(35)

.089

Month after

150

(36.1)

.011

noted in the average Daily ED visits except for the month after that had a higher average compared with Friday the 13th (150 vs 135, P = .011). Of the 13 variables evaluated, only visits for penetrating trauma was higher on Friday the 13th compared with the other dates (odds ratio, 1.65; 95% confidence interval, 1.04-2.61). No other variable showed an increase in ED visits (Fig. 1).

Discussion

Misfortune is associated both with the number 13 and the day “Friday.” The combination of these unlucky items is considered especially cursed. It is estimated that because of this day, approximately $900 million (US) in business and productivity is lost because of people altering their normal lives [13].

In Judeo-Christian beliefs, Friday is considered unlucky because it was the day Jesus was crucified. Maritime lore claims that it is unlucky to begin a voyage on a Friday. Urban legend states that the British Navy once launched a ship named the HMS Friday that met with disastrous conse- quences [14]. So entrenched is the belief that Friday is an unlucky day that the appellation “Black Friday” is given to any Friday on which a disaster occurs.

The number 13 is also considered unlucky also for several reasons. In Christianity, Judas (the disciple that betrays Jesus) was the 13th guest to arrive during the Last Supper. This story was the basis for the belief that 13 diners at 1 table were unlucky as one of the diners would die in the next year. The belief that Friday the 13th is unlucky also has had many origins. In the Norse mythology, the goddess Frigga, for whom Friday is named, was banished to a mountaintop. In retaliation, Frigga would meet on Friday to conspire with the devil and 11 witches (for a total of 13 conspirators) to wreak havoc for the upcoming week [15]. The fear of Friday the 13th has also been fueled by Pop culture including a

series of horror movies titled with the same name.

Few studies have attempted to examine the influence of Friday the 13th on ED use [16-19]. Two studies showed an increase risk for female drivers, whereas another study showed no increase risk [19]. The study by Nayha [18] concluded that because women were likely to be in more traffic accidents, they may suffer from a higher level of anxiety. Our study showed no increase risk in both the total number of MVCs as well as female patients from MVCs presenting to the ED. There was also no increase in the number of psychiatric visits to the ED or the number of female psychiatric visits on Friday the 13th. Thus, there is no reason for women to fear driving or risk having a psychiatric condition requiring evaluation in the ED.

In our study, visits to the ED were also not increased on Friday the 13th. In fact, Friday the 13th had fewer visits compared with the month after. Of the 13 conditions evaluated, only penetrating trauma had an increase in risk

Psychiatric Visits (female)

1.04

1.05

1.1

1.65

1.11

1.05

1.11

0.68

0.83

1.26

0.97

0.99

1.01

Psychiatric Visits trauma admissions Penetrating Trauma

MVC (female)

MVC

Surgical Admissions (Non- Trauma)

Animal Bites

Seizure CVA/TIA

ACS

Medical Admits Female Patients

0.00 0.50 1.00 1.50 2.00 2.50 3.00

Favors Control Favors Friday the 13th

Fig. 1 Odds ratio (95% confidence interval) for different variables. ACS = acute coronary syndrome; CVA/TIA= cerebrovascular accidents/ transient ischemic attack; MVC = motor vehicle collision.

on Friday the 13th. It is possible that people alter their behavior because of their superstitions, thereby avoiding riskier activities and accounting for the lack of increased ED visits.

Comparison with other superstitions

This is the first report that we are aware of that has looked at the ED use on Friday the 13th on a large scale. Numerous studies have looked at other superstitions, especially the effects of the full moon. Most studies have shown no effect on the ED use with the full moon. However, 1 study showed an increase in animal bites [11]. In our study, there was no increase in the number of animal bites presenting to the ED.

Strengths and limitations

One of the biggest strengths is the size of our study. Previous studies that have evaluated Friday the 13th on ED use only looked at 1 Friday the 13th. Thus, the statistical analyses in those studies are limited in their generalization. This is likely because of the limited occurrences of Friday the 13th. Unfortunately, not all 13 Friday the 13th were able to be analyzed at all hospitals. This limitation at some of the hospitals occurred because of the unavailability of records before the implementation of the electronic medical record/ Tracking system at those facilities. Nevertheless, we feel that we have had a reasonably large number to still effectively evaluate its effects.

Conclusion and implications

Most conditions studied did not have an increased risk of presenting to the ED on Friday the 13th compared with other

Fridays and other dates that included the 13th of the month. Thus, there is no need for providers to implement strategies to avoid working those days. The ED on Friday the 13th will be just as crazy as any other day.

References

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(Accessed January 19, 2011).

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