title: The Impact of Heat on an Emergency Department in Italy: Attributable Visits among Children, Adults, and the Elderly during the Warm Season.
abstract: BACKGROUND
  Recent studies suggest that heat is associated with an increase in the number of ambulance calls and emergency department visits. We investigated the association between heat and daily number of emergency department visits at the University Hospital of Verona during the warm seasons 2011-2012 and we assessed the magnitude of the impact in terms of attributable events, focusing on the role of age and triage codification.
  
  
  METHODS
  We used a Poisson model to analyse the association between daily number of visits and daily mean apparent temperature, accounting for air pollution level and seasonality. The analyses were stratified by age group and were performed both on the total number of emergency department visits and on the subsample of high-priority visits. Impact estimates were obtained only for this subsample, using a Monte Carlo approach to account for sampling variability. Number of attributable events and attributable community rate were calculated.
  
  
  RESULTS
  We found a positive and immediate association between event occurrence and mean apparent temperatures exceeding a threshold located around 28-29°C. The estimated percent change in the total number of visits per 1°C increase of exposure above the threshold was equal to 3.75 (90% CI: 3.01; 4.49). Focusing only on high-priority visits, the estimated percent change was larger and the greatest effect was among children. We estimated that apparent temperatures above the threshold were responsible for 1177 high-priority visits during the study period. Due to the record high temperatures observed in 2012 in Italy and in Europe, the impact in 2012 was much larger than in 2011, and consisted in 34 high-priority visits every 10000 children, 30 every 10000 people aged 15-64, and 38 every 10000 people aged 65 and over.
  
  
  CONCLUSIONS
  Our results indicate that heat affects not only the elderly, but also children and non-elderly adults, stressing the need for developing public health preparedness plans for the entire community.
authors.affiliation: Department of Statistics, Informatics and Applications ''G. Parenti", University of Florence, Florence, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Ghirardi
authors.affiliation: Research Support and Biostatistical Unit, University Hospital Verona, Verona, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Bisoffi
authors.affiliation: Research Support and Biostatistical Unit, University Hospital Verona, Verona, Italy.
authors.forename: Rina
authors.initials: R
authors.lastname: Mirandola
authors.affiliation: Accident and Emergency Department, University Hospital Verona, Verona, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Ricci
authors.affiliation: Department of Statistics, Informatics and Applications ''G. Parenti", University of Florence, Florence, Italy; Biostatistics Unit, ISPO Cancer Prevention and Research Institute, Florence, Italy.
authors.forename: Michela
authors.initials: M
authors.lastname: Baccini
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006358:Hot Temperature; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007558:Italy; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D055815:Young Adult