People use discretion in deciding when show up in the emergency department

When is a medical emergency really an emergency? Not during key Boston Red Sox games, report investigators from Children's Hospital Boston in a letter published in the October issue of Annals of Emergency Medicine.

Although previous studies have found a decline in health-care use during major sporting events, the Children's researchers are the first to quantify the magnitude of the events -- using television Nielsen ratings -- showing that the bigger or more suspenseful the event, the quieter the emergency department.

Borrowing data from a real-time disease surveillance system developed at Children's, the researchers tracked hourly visit rates at six Boston-area emergency departments during the each of the 2004 American League Championship Series (ALCS) and World Series games. They plotted these rates against television viewership as indicated by local Nielsen ratings.

During the lowest-rated games -- ALCS games 3 and 4, when the Red Sox were losing and facing probable elimination -- visits to the emergency room were about 15 percent above the volume expected, after adjusting for time of day, day of week, and seasonal factors like flu that can cause spikes in visit rates.

But then, the Red Sox won game 4. During game 5, Nielsen ratings surged and ER visits dipped about 5 percent below normal volume. During the highest-rated games -- the ALCS final game 7 and the World Series final game 4 -- fully 55-60 percent of Boston-area households tuned in and emergency-department visits dipped about 15 percent below the expected volume.

Gripped by Red Sox fever during the 2004 postseason, the study's key researchers, Drs. John Brownstein and Ben Reis of Children's programs in Informatics and Emergency Medicine decided to tap into the emergency department's Automated Epidemiological Geotemporal Integrated Surveillance system, or AEGIS, after the World Series concluded. AEGIS, a disease-monitoring system that has been expanded for use by the Massachusetts Department of Public Health, analyzes patient data anonymously and compares it with data from previous medical visits, flagging abnormal disease clusters or symptom patterns.

After a week of late nights crunching and plotting data for the hours in question, Brownstein and Reis, also affiliated with Harvard Medical School, were able to show an inverse relationship between Red Sox viewership and emergency-department visits that held up under rigorous statistical tests.

"The public health finding here is people use discretion in deciding when show up in the emergency department," says senior study author Dr. Kenneth Mandl, an attending physician in Children's Department of Emergency Medicine and a faculty member of the Children's Hospital Informatics Program at the Harvard-MIT Division of Health Sciences and Technology.

A previous study documented an increase in driving fatalities on Super Bowl Sunday. However, Brownstein and Reis looked at emergency department results only during the hours of the games themselves, not afterward when drunken fans might be driving. It also examined all categories of visits, including routine health visits.

The hospitals analyzed were Children's, Beth Israel Deaconess Medical Center, Massachusetts General Hospital Cambridge Hospital, Somerville Hospital, and Whidden Memorial Hospital (serving the communities of Everett, Revere, Chelsea, Winthrop, and Malden).