OJEM  Vol.4 No.2 , June 2016
Seasonality of ER Admissions in Northwestern Pennsylvania: A Cross-Sectional Study
Abstract: Seasonality, in the context of emergency room (ER) admissions, can be described as the periodic incidence of disease, corresponding to seasons, or other pre-established calendar periods. Respiratory diseases, in general, show a seasonal pattern with incidence peak at the winter season, however research still presents a considerable amount of inconsistency. Incidence of cardiovascular diseases (CVD) is also very well linked to the cold season. Gastrointestinal, genitourinary and neurological diseases are poorly studied in regards their seasonal patterns. This study aimed to assess seasonality of the five categories of diseases–respiratory, cardiovascular, gastrointestinal, genitourinary, and neurological-using data from a community hospital in northwestern PA. We analyzed 14 years (2000-2014) of data from the Meadville Medical Center (MMC) ER admissions. For each ER admission case, we had information about ICD-9 code, sex, insurance, race, age and date, time and year of admission. Statistical analyses were performed using SAS 9.4 University version software. We found significantly fewer cases of respiratory diseases in spring (OR = 0.757), summer (OR = 0.579), and fall (OR = 0.741), when comparing to the winter season; however, seasonal differences were not found for cardiovascular, genitourinary, and neurological diseases. The implications of these results will primarily be used to improve Meadville’s public health policies for cold seasons, and more specifically, implement programs that prepare the ER to receive and treat respiratory cases more efficiently in the cold season.
Cite this paper: Guimaraes, T. and Dawson, R. (2016) Seasonality of ER Admissions in Northwestern Pennsylvania: A Cross-Sectional Study. Open Journal of Emergency Medicine, 4, 45-52. doi: 10.4236/ojem.2016.42007.

[1]   Dowell, S.F. (2001) Seasonal Variation in Host Susceptibility and Cycles of Certain Infectious Diseases. Emergency Infectious Diseases, 7, 369-374.

[2]   Grassly, N.C. and Fraser, C. (2006) Seasonal Infectious Disease Epidemiology. ProcBiolSci, 273, 2541-2550.

[3]   Fisman, D.N. (2007) Seasonality of Infectious Diseases. Annual Review of Public Health, 28, 127-143.

[4]   Desalu, O.O. (2011) Seasonal Variation in Hospitalisation for Respiratory Diseases in the Tropical Rain Forest of South Western Nigeria. The Nigerian Postgraduate Medical Journal, 18, 39-43.

[5]   Douglas, A.S., Rawles, J.M., Alexander, E. and Allan, T.M. (1991) Winter Pressure on Hospital Beds. British Medical Journal, 303, 508-509.

[6]   Schrijver, T.V., Brand, P.L.P. and Bekhof, J. (2016) Seasonal Variation of Diseases in Children: A 6-Year Prospective Cohort Study in a General Hospital. European Journal of Pediatrics, 175, 457-464.

[7]   Yang, T.O., Huang, W., Chen, M. and Chen, P. (2014) Seasonal Synchrony in Incidences of Commons Infectious Diagnoses in Early Childhood among Neighbouring Regions. International Journal of Infectious Diseases, 28, 214-216.

[8]   Andersen, I.B., Lundqvist, G.R. and Proctor, D.F. (1972) Human Nasal Mucosal Function under Four Controlled Humidities. The American Review of Respiratory Diseases, 106, 438-449.

[9]   Baetjer, A.M. (1968) Role of Environmental Temperature and Humidity in Susceptibility to Disease. Archives of Environmental Health, 16, 565-570.

[10]   Agius, A.M., Smallman, L.A. and Pahor, A.L. (1998) Age, Smoking, and Nasal Ciliary Beat Frequency. Clinical Otolaryngology, 23, 227-230.

[11]   Grose, E.C., et al. (1982) Pulmonary Host Defense Responses to Inhalation of Sulfuric Acid and Ozone. Journal of Toxicology and Environmental Health, 10, 351-362.

[12]   Verra, F., Escudier, E., Lebargy, F., Bernaudin, J.F., De Cremoux, H. and Bignon, J. (1995) Ciliary Abnormalities in Bronchial Epithelium of Smokers, Ex-Smokers, and Nonsmokers. American Journal of Respiratory and Critical Care Medicine, 151, 630-634.

[13]   Ross, A., Collins, M. and Sanders, C. (1990) Upper Respiratory Tract Infection in Children, Domestic Temperatures, and Humidity. Journal of Epidemiology and Community Health, 44, 142-146.

[14]   Spengler, J.D., Jaakkola, J.J., Parise, H., Katsnelson, B.A., Privalova, L.I. and Kosheleva, A.A. (2004) Housing Characteristics and Children’s Respiratory Health in the RUSSIAN federation. American Journal of Public Health, 94, 657-662.

[15]   Douglas, A.S., Strachan, D.P. and Maxwell, J.D. (1996) Seasonality of Tuberculosis: The Reverse of Other Respiratory Diseases in the UK. Thorax, 51, 944-946.

[16]   Ornato, J.P., Peberdy, M.A., Chandra, N.C. and Bush, D.E. (1996) Seasonal Pattern of Acute Myocardial Infarction in the National Registry of Myocardial Infarction. Journal of the American College of Cardiology, 28, 1684-1688.

[17]   Arntz, H.R., Willich, S.N., Schreiber, C., Bruggemann, T., Stern, R. and Schultheiss, H.P. (2000) Diurnal, Weekly and Seasonal Variation of Sudden Death: Population-Based Analysis of 24,061 Consecutive Cases. European Health Journal, 21, 315-320.

[18]   Boulay, F., Berthier, F., Sisteron, O., Gendreike, Y. and Gibelin, P. (1999) Seasonal Variation in Chronic Heart Failure Hospitalizations and Mortality in France. Circulation, 100, 280-286.

[19]   Mehta, R.H., et al. (2002) Chronobiological Patterns of Acute Aortic Dissection. Circulation, 106, 1110-1115.

[20]   Comelli, I., Ferro, J., Lippi, G., Comelli, D., Sartori, E. and Cervellin, G. (2014) Incidence of Acute-Onset Atrial Fibrillation Correlates with Air Temperature—Results of a Nine-Year Survey. Journal of Epidemiology and Global Health, 4, 151-157.

[21]   Khan, R.C. and Halder, D. (2014) Effect of Seasonal Variation on Hospital Admission Due to Cardiovascular Diseases—Findings from an Observational Study in a Divisional Hospital in Bangladesh. BMC Cardiovascular Disorders, 14, 76-82.

[22]   Mamun, M.A., Rumana, N., Kita, Y. and Turin, T.C. (2014) Combining the Effects of Conventional Risk Factors and Environmental Triggering Factors While Studying Seasonality in Acute Myocardial Infarction. Environmental Pollution, 189, 252-253.

[23]   Abrignani, M.G., et al. (2009) Influence of Climatic Variables on Acute Myocardial Infarction Hospital Admissions. International Journal of Cardiology, 137, 123-129.

[24]   Kuma, N., Venkatraman, A. and Garg, N. (2015) Seasonality in Acute Ischemic Stroke Related Hospitalizations and Case Fatality Rate in the United States. International Journal of Cardiology, 195, 134-135.

[25]   Reavey, M., Saner, H., Paccaud, F. and Marques-Vidal, P. (2013) Exploring the Periodicity of Cardiovascular Events in Switzerland: Variations in Deaths and Hospitalizations across Seasons, Day of the Week, and Hour of the Day. International Journal of Cardiology, 168, 2195-2200.

[26]   Qui, H., et al. (2013) Is Greater Temperature Change within a Day Associated with Increased Emergency Hospital Admissions for Heart Failure? Circulation: Heart Failure, 6, 930-935.

[27]   Brennan, P.J., Greenberg, G., Miall, W.E. and Thompson, S.G. (1982) Seasonal Variation in Arterial Blood Pressure. British Medical Journal, 285, 919-923.

[28]   Modest, P.A. (2013) Seasonal Blood Pressure Changes: An Independent Relationship with Temperature and Daylight Hours. Hypertension, 61, 908-914.

[29]   Marti-Soler, H., et al. (2014) Seasonality of Cardiovascular Risk Factors: An Analysis Including over 230 000 Participants in 15 Countries. Heart, 100, 1517-1523.

[30]   Jung, Y.S., et al. (2013) Seasonal Variation in Months of Birth and Symptom Flares in Korean Patients with Inflammatory Bowel Disease. Gut and Liver, 7, 661-667.

[31]   Lee, J.H., Cheon, J.H., Hong, S.P., Kim, T.I. and Kim, W.H. (2015) Seasonal Variation in Flares of Intestinal Beh?et’s Disease. Digestive Diseases and Science, 60, 3373-3378.

[32]   Ilves, I., Fagerstr?m, A., Herzig, K.-H., Juvonen, P., Miettinen, P. and Paajanen, H. (2014) Seasonal Variations of Acute Appendicitis and Nonspecific Abdominal Pain in Finland. World Journal of Gastroenterology, 20, 4037-4042.

[33]   Harper, S.L., Edge, V.L., Schuster-Wallace, C.J., Berke, O. and McEwen, S.A. (2011) Weather, Water Quality and Infectious Gastrointestinal Illness in Two Inuit Communities in Nunatsiavut, Canada: Potential Implications for Climate Change. EcoHealth, 8, 93-108.

[34]   Koido, S., et al. (2013) Seasonal Variations in the Onset of Ulcerative Colitis in Japan. World Journal of Gastroenterology, 19, 9063-9068.

[35]   Raboni, S.M., et al. (2014) Acute Gastroenteritis and Enteric Viruses in Hospitalised Children in Southern Brazil: Aetiology, Seasonality and Clinical Outcomes. Memórias do Instituto Oswaldo Cruz, 109, 428-435.

[36]   Kulinkina, A.V., et al. (2016) Seasonality of Water Quality and Diarrheal Diseases Counts in Urban and Rural Settings in South India. Nature, 6, Article No. 20521.

[37]   Jagai, J.S., Griffiths, J.K., Kirshen, P.K., Webb, P. and Naumova, E.N. (2012) Seasonal Patterns of Gastrointestinal Illness and Streamflow along the Ohio River. International Journal of Environmental Research and Public Health, 9, 1771-1790.

[38]   Rossignol, L., Pelat, C., Lambert, B., Flahault, A., Chartier-Kastler, E. and Hanslik, T. (2013) A Method to Assess Seasonality of Urinary Tract Infections Based on Medication Sales and Google Trends. PLoS ONE, 8, e76020.

[39]   Gardner, A., et al. (2014) A Systematic Review of Concussion in Rugby League. British Journal of Sports Medicine, 49, 495-498.

[40]   Kica, J. and Rosenman, K.D. (2014) Surveillance for Work-Related Skull Fractures in Michigan. Journal of Safety Research, 51, 49-56.

[41]   Muto, M., Mori, M., Sato, Y., Uzawa, A., Masuda, S. and Kuwabara, S. (2012) Seasonality of Multiple Sclerosis and Neuromyelitis Optica Exacerbations in Japan. Multiple Sclerosis Journal, 19, 378-379.

[42]   Petersen, B.B., Moller, J.K. and Vilholm, O.J. (2015) Season Is an Unreliable Predictor of Lyme Neuroborreliosis. Danish Medical Journal, 62, A5084.

[43]   D’Souza, R.M., et al. (2007) Seasonal Variation in Acute Hospital Admissions and Emergency Room Presentations among Children in the Australian Capital Territory. Journal of Paediatrics and Child Health, 43, 359-365.

[44]   Harvell, C.D., et al. (2002) Climate Warming and Disease Risks for Terrestrial and Marine Biota. Science, 296, 2158- 2162.

[45]   Kuhn, K., Campbell-Lendrum, D., Haines, A. and Cox, J. (2005) Using Climate to Predict Infectious Disease Epidemics. World Health Organ, Geneva.

[46]   Zaborowski, M. and Dawson, R. (2016) Emergency Department Admissions for Dental & Oral Health Concerns in Rural Northwestern Pennsylvania. Open Journal of Emergency Medicine, 4, 23-32.

[47]   AAPC (2016) ICD-9-CM Code Set.

[48]   Zhang, Y., et al. (2015) Burden of Respiratory Syncytial Virus Infections in China: Systematic Review and Meta- Analysis. Journal of Global Health, 5, 020417.