Circadian pattern of intubation rates in ED patients with congestive heart failure.
OBJECTIVE
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.


METHODS
We performed a retrospective cohort study of consecutive patients seen by emergency department physicians in 15 hospital emergency departments (1996-2003).


RESULTS
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).


CONCLUSIONS
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.
Morristown Memorial Hospital Residency in Emergency Medicine, Morristown, NJ 07962, USA. johnalle@verizon.net
John R
JR
Allegra
Barnet
B
Eskin
Jeffery
J
Kleinberg
Dennis G
DG
Cochrane
D000368:Aged; D002940:Circadian Rhythm; D004630:Emergencies; D005260:Female; D006333:Heart Failure / Q000453:epidemiology* / Q000628:therapy*; D006801:Humans; D015994:Incidence; D007442:Intubation, Intratracheal; D008297:Male; D009515:New Jersey / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors