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Abstract. Objective: To determine whether there are patterns in the incidence of emergency department (ED) visits for congestive heart failure (CHF) by month of the year, day of the week, or hour of the day. Methods: This was a retrospective analysis of a computerized billing database of ED visits, involving seven northern New Jersey hospitals EDs. Consecutive patients seen by emergency physicians over an 11-year period (January 1, 1988-December 31, 1998) were included. Chi-square tests were used to evaluate for significant differences (p < 0.05). Results: There were a total of 2,370,233 patients in the database, of whom 26,224 had a primary ED diagnosis of CHF. The chi-square test rejected uniformity for month of the year, for day of the week, and for hour of the day (p < 0.0001). Visits for CHF were increased in the winter months. Compared with the average of the other months, December was the highest (14.3% above, p < 0.0001) and August was the lowest (15.5% below, p < 0.0001). There was also a day-of-the-week variation. Compared with the average of the other days, Monday was the highest (14.5% above, p < 0.0001) and Saturday was the lowest (9.6% below, p < 0.0001). There was also an hour-ofthe-day pattern, with a rapid rise after 8 AM and a downtrend after 3 PM. Conclusions: These data revealed a higher incidence of ED visits for CHF in the winter months, on Mondays, and during the hours of 8 AM to 3 PM. In comparison with previous studies, these data revealed a similar pattern by month of the year and a different pattern by hour of the day. Key words: congestive heart failure; pulmonary edema; seasonal; weekly; circadian. ACADEMIC EMERGENCY MEDICINE 2001; 8:682-685 Hypertensive heart disease malignant with congestive heart disease 402.11Hypertensive heart disease benign with congestive heart failure 402.91Hypertensive heart disease unspecified with congestive heart failure 428.9Heart failure unspecified 404.91Hypertensive heart and renal disease unspecified with congestive heart failure 404. 93 Hypertensive heart and renal disease with congestive heart failure and renal failure 518.4Acute edema of lung, unspecified 398.91Rheumatic heart failure (congestive)Temporal patterns in the incidence of congestive heart failure (CHF) may offer clues to precipitating factors, particularly the influence of climate and other stresses. There are only a few studies 1-5 that have analyzed the incidence of CHF by sea- analyzed data from an emergency department (ED) in the United States, and that study included just 103 patients. These studies found a predominance of visits in the winter and a peak late in the day and in the early hours of the morning. The objective of our study was to determine whether our cohort showed similar patterns in the incidence of ED visits for CHF by month of the year and hour of the day, and if a pattern exists by day of the week. METHODSStudy Design. This study was a retrospective analysis of a computerized billing database of ED visits. The institutional review board at the authors' inst...

Objective: Standardized surveillance syndromes do not exist but would facilitate sharing data among surveillance systems and comparing the accuracy of existing systems. The objective of this study was to create reference syndrome definitions from a consensus of investigators who currently have or are building syndromic surveillance systems. Design: Clinical condition–syndrome pairs were catalogued for 10 surveillance systems across the United States and the representatives of these systems were brought together for a workshop to discuss consensus syndrome definitions. Results: Consensus syndrome definitions were generated for the four syndromes monitored by the majority of the 10 participating surveillance systems: Respiratory, gastrointestinal, constitutional, and influenza-like illness (ILI). An important element in coming to consensus quickly was the development of a sensitive and specific definition for respiratory and gastrointestinal syndromes. After the workshop, the definitions were refined and supplemented with keywords and regular expressions, the keywords were mapped to standard vocabularies, and a web ontology language (OWL) ontology was created. Limitations: The consensus definitions have not yet been validated through implementation. Conclusion: The consensus definitions provide an explicit description of the current state-of-the-art syndromes used in automated surveillance, which can subsequently be systematically evaluated against real data to improve the definitions. The method for creating consensus definitions could be applied to other domains that have diverse existing definitions.

Contrary to the traditional belief that more cardiopulmonary resuscitations occur during the full moon, we were unable to identify a significant effect during full moon days. However, there were on average 6.5% fewer cardiopulmonary resuscitations during new moon days than other days.

The higher stress associated with the World Trade Center (WTC) attacks on September 11, 2001, may have resulted in more cardiac events particularly in those living in close proximity. Our goal was to determine if there was an increase in cardiac events in a subset of emergency departments (EDs) within a 50-mi radius of the WTC. We performed a retrospective analysis of consecutive patients seen by ED physicians in 16 EDs for the 60 days before and after September 11 in 2000-2002. We determined the number of patients admitted to an inpatient bed with a primary or secondary diagnosis of acute myocardial infarction (MI) or tachyarrhythmia. In each year, we compared patient visits for the 60 days before and after September 11 using the chi-square statistic. For the 360 days during the 3 years, there were 571,079 patient visits in the database of which 110,766 (19.4%) were admitted. Comparing the 60 days before and after September 11, 2001, we found a statistically significant increase in patients with MIs (79 patients before versus 118 patients after, P =.01), representing an increase of 49%. There were no statistically significant differences for MIs in 2000 and 2002 and in tachyarrhythmias for all three years. For the 60-day period after September 11, 2001, we found a statistically significant increase in the number of patients presenting with acute MI but no increase in patients admitted with tachyarrhythmias.