The association between birthdays and medical emergencies

Background: Not many studies have examined the risk of emergency medical attendance during stressful life events or special days such as birthdays. This study looked at whether patients had a higher than normal chance of attending the emergency departments around their birthdays compared to the rest of the year. Methods: Patient attendance data were collected from our accident and emergency department from April 2013 to March 2014. The birthday of individual patients was matched with their date of attendance to find out the number of patients attending emergency department on and around their birthdays. Chi-square test and binominal distribution test were used to compare birthday attendances with those occurring at other times of the year. Results: A total of 1028 patients attended within the 7 days starting from their birthday (expected number 49, 211/52 = 946). This was found to be statistically significant (P = 0.0071). Road traffic accidents were more frequent on both the birthday week and the week after birthday. Medical emergencies, injury in a public place, 19–35 years age group and male patients showed similarly significant association but for the week after birthday only. Conclusions: People are more likely to present to emergency departments in the week starting from their birthday than any other week of the year. There is scope for public health initiatives such as sending health education information in the form of a birthday card to raise awareness of this risk

Hip fractures sustained in hospital:comorbidities and outcome

ABSTRACT Background Guidelines on the management of hip fracture in the elderly focus on fractures suffered in the community. Between 4% and 7% of hip fractures occur in hospital. Mortality is higher in those who sustain hip fracture in hospital than those who sustain a fracture in the community. However, it is not known if sustaining a nosocomial fracture is an independent risk factor for a poor outcome. Objective To compare outcomes of hip fracture sustained in the community and sustained while in hospital for another reason. After adjusting for confounders, we sought to determine if sustaining a fracture in hospital was an independent risk factor for a poor outcome. Methods Using the National Hip Fracture Database, we identified all patients admitted to Leicester Royal Infirmary with hip fracture between July 2009 and February 2013. We extracted demographic data, details of comorbidity, and 30-day and long-term mortality. Age, gender, American Society of Anaesthesiologists (ASA) grade, time to surgery, and survival were compared between patients with hospital-acquired and those with community-acquired hip fracture. Results During the study period, 2987 patients were treated for hip fracture; 2984 were included in the study. Of these, 261 (8.7%) sustained the fracture while in hospital. Those who sustained the fracture in hospital were more commonly men (106/261 (41%)) than those with a community-acquired fracture (738/2723 (27%)) and had a worse ASA grade (III or IV, 215/230 (93%) vs 1647/2573 (64%)). Thirty-day mortality was higher in those with a hospital-acquired fracture (48/261 (18%)) than in those with a community-acquired fracture (212/2723 (7.8%)) (p&amp;lt;0.001). However, after adjustment for confounding variables, the association between hip fracture, in-hospital and 30-day mortality was not significant: OR 1.2 (95% CI 0.8 to 2.0), p=0.40. Longer-term mortality was associated with hip fracture in hospital after adjustment for confounding variables in multivariate proportional hazards regression: HR 1.5 (95% CI 1.2 to 1.8), p&amp;lt;0.001. Conclusions Patients who sustain hip fractures in hospital are unsurprisingly sicker than those who sustain hip fractures in the community. Although being in hospital is not an independent risk factor, this easily identifiable group of patients are at particular risk of a poor outcome. We suggest that it might be appropriate to consider modifying the guidelines for treatment of hip fracture for this group in an attempt to improve outcome. </jats:sec