title: Temporal variation of out-of-hospital cardiac arrests in an equatorial climate.
abstract: OBJECTIVE
  We aimed to determine whether there is a seasonal variation of out-of-hospital cardiac arrests (OHCA) in an equatorial climate, which does not experience seasonal environmental change.
  
  
  METHODS
  We conducted an observational prospective study looking at the occurrence of OHCA in Singapore. Included were all patients with OHCA presented to Emergency Departments across the country. We examined the monthly, daily, and hourly number of cases over a three-year period. Data was analyzed using analysis of variance (ANOVA).
  
  
  RESULTS
  From October, 1st 2001 to October, 14th 2004, 2428 patients were enrolled in the study. Mean age for cardiac arrests was 60.6 years with 68.0% male. Ethnic distribution was 69.5% Chinese, 15.0% Malay, 11.0% Indian, and 4.4% Others. There was no significant seasonal variation (spring/summer/fall/winter) of events (ANOVA P = 0.71), monthly variation (P = 0.88) or yearly variation (P = 0.26). We did find weekly peaks on Mondays and a circadian pattern with daily peaks from 9-10 am.
  
  
  CONCLUSIONS
  We did not find any discernable seasonal pattern of cardiac arrests. This contrasts with findings from temperate countries and suggests a climatic influence on cardiac arrest occurrence. We also found that sudden cardiac arrests follow a circadian pattern.
authors.affiliation: Department of Emergency Medicine, Singapore General Hospital, Singapore.
authors.forename: Marcus Eh
authors.initials: ME
authors.lastname: Ong
authors.affiliation: Clinical Trials and Epidemiology Research Unit (now known as Singapore Clinical Research Institute), Singapore.
authors.forename: Faith Sp
authors.initials: FS
authors.lastname: Ng
authors.affiliation: Department of Emergency Medicine, Singapore General Hospital, Singapore.
authors.forename: Susan
authors.initials: S
authors.lastname: Yap
authors.affiliation: Department of Emergency Medicine, Singapore General Hospital, Singapore.
authors.forename: Kok Leong
authors.initials: KL
authors.lastname: Yong
authors.affiliation: Division of Cardiology, Virginia Commonwealth University - Medical College of Virginia, Richmond, VA, USA.
authors.forename: Mary A
authors.initials: MA
authors.lastname: Peberdy
authors.affiliation: Department of Emergency Medicine, Virginia Commonwealth University - Medical College of Virginia, Richmond, VA, USA.
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Ornato
keywords: cardiac arrest; cardiopulmonary resuscitation; circadian pattern; seasonal pattern