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Circadian pattern of intubation rates in ED patients with congestive heart failure
John R Allegra1, Barnet Eskin, Jeffery Kleinberg
1Morristown Memorial Hospital Residency in Emergency Medicine, Morristown, NJ 07962, USA. johnalle@verizon.net
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.
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