title: Diurnal and seasonal patterns in presentations with hip fracture-data from the national hip fracture database.
abstract: we set out to examine diurnal and seasonal variation in hip fracture presentations to question their origin and to consider their implications for the organisation of health services for older people.
  
  
  
  we used the National Hip Fracture Database to identify the time of presentation and surgery for 64,102 patients; all those older than 60 years who sustained this injury in England, Wales and Northern Ireland during 2014.
  
  
  
  we found marked diurnal variation in rates of presentation, increasing sharply after 0800 hours and decreasing only after 1800 hours. Among people who sustained their hip fracture in hospital (n = 2,761) or in a care home (n = 12,141), there were peaks in presentations around 0900 and 1800 hours. Time of presentation had a very marked effect on whether surgery was delayed by more than 24 hours but less against the national guidelines of surgery within 36 hours or by the next day. There were 15.6% more presentations during December compared to all other months (9.5% versus 8.2%, P < 0.001), a pattern also found among people living in care homes (9.1% versus 8.3%, P < 0.001).
  
  
  
  we have identified morning and evening peaks of presentation for inpatients and care home residents and a December increase in overall hip fracture numbers. These patterns warrant further investigation if those organising health services are to prevent this injury, and to provide appropriate beds and prompt operations for the people who sustain it.
authors: Trauma Unit, University Hospital of Wales, Cardiff, UK.|National Hip Fracture Database, Falls and Fragility Fracture Audit Programme, Royal College of Physicians, London, UK.|Department of Public Health, Swansea University, Swansea, UK.
authors: Antony
authors: A
authors: Johansen
authors: National Hip Fracture Database, Falls and Fragility Fracture Audit Programme, Royal College of Physicians, London, UK.
authors: Christopher
authors: C
authors: Boulton
authors: Nuffield Trust, London, UK.
authors: Jenny
authors: J
authors: Neuburger
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data*; D000369:Aged, 80 and over; D002940:Circadian Rhythm; D016208:Databases, Factual; D005260:Female; D006620:Hip Fractures / Q000175:diagnosis / Q000453:epidemiology*; D006707:Homes for the Aged / Q000639:trends; D006801:Humans; D057187:Independent Living / Q000639:trends; D007297:Inpatients / Q000706:statistics & numerical data; D008297:Male; D009735:Nursing Homes / Q000639:trends; D012621:Seasons; D013997:Time Factors; D006113:United Kingdom / Q000453:epidemiology
keywords: diurnal variation; falls; hip fracture; older people; seasonal variation; surgery