title: Twenty-four-hour pattern in emergency department presentation for sickle cell vaso-occlusive pain crisis.
abstract: The objective of this study was to determine in a significant temporal pattern exists in the presentation of sickle cell vaso-occlusive pain crisis (SC-VPC) patients to an emergency department (ED) for treatment. This 28-month retrospective study of ED sickle cell crisis treatment involved 1128 presumably diurnally active SCVPC patients presenting to the ED of a university-affiliated hospital between January 1, 1991 and April 30, 1993. Data for adult subjects (> or equal to 15 years) were used for analysis. Date and time of presentation for each patient were recorded. Data were submitted to chi 2 and single cosinor analysis for determination of circadian and circannual patterns. chi 2 analysis suggested that the incidence of SCVPC events treated in the ED was not equally distributed throughout the 24 h. Single cosinor analysis identified a significant circadian rhythm (p < 0.001) for all subjects, with peak ED presentations occurring in the early evening. The best-fit cosine curve accounted for 50% of the sample variance. While the etiology of this finding is unclear, determination of a temporal pattern in SCVPC presentation to the ED may lead to identification and control of conditions that precede the occurrence of a SCVPC. Interventions for SCVPC may require modification based on chronobiological trends.
authors.affiliation: School of Nursing, Case Western Reserve University, Cleveland, Ohio 44106, USA.
authors.forename: S E
authors.initials: SE
authors.lastname: Auvil-Novak
authors.forename: R D
authors.initials: RD
authors.lastname: Novak
authors.forename: N
authors.initials: N
authors.lastname: el Sanadi
mesh_terms: D000328:Adult; D000700:Analgesics / Q000008:administration & dosage; D000755:Anemia, Sickle Cell / Q000188:drug therapy / Q000503:physiopathology*; D002940:Circadian Rhythm / Q000502:physiology*; D004636:Emergency Service, Hospital; D006801:Humans; D010146:Pain / Q000188:drug therapy / Q000503:physiopathology; D012189:Retrospective Studies
chemical_list: D000700:Analgesics