Twenty-Four-Hour Pattern in Emergency Department Presentation for Sickle Cell Vaso-Occlusive pain Crisis

Abstract

The objective of this study was to determine in a significant temporal pattern exists in the presentation of sickle cell vaso-occlusive pain crisis (SC-VPC) patients to an emergency department (ED) for treatment. This 28-month retrospective study of ED sickle cell crisis treatment involved 1128 presumably diurnally active SCVPC patients presenting to the ED of a university-affiliated hospital between January 1, 1991 and April 30, 1993. Data for adult subjects (> or equal to 15 years) were used for analysis. Date and time of presentation for each patient were recorded. Data were submitted to chi 2 and single cosinor analysis for determination of circadian and circannual patterns. chi 2 analysis suggested that the incidence of SCVPC events treated in the ED was not equally distributed throughout the 24 h. Single cosinor analysis identified a significant circadian rhythm (p < 0.001) for all subjects, with peak ED presentations occurring in the early evening. The best-fit cosine curve accounted for 50% of the sample variance. While the etiology of this finding is unclear, determination of a temporal pattern in SCVPC presentation to the ED may lead to identification and control of conditions that precede the occurrence of a SCVPC. Interventions for SCVPC may require modification based on chronobiological trends.

Circadian control of the immune system

“…Leukocyte adhesion plays a critical role in sickle cell vaso-occlusion as mortality is prevented in mice deficient in both P- and E-selectin 60, 61 . Circadian time affects vaso-occlusive events in humans 49 and mice 7 , further supporting their contribution to circadian onset of vascular diseases. It is likely that multiple circadian-regulated cellular and humoral factors modulate disease onset and progression.…”

“…Several chronic diseases are known to exhibit circadian exacerbations in their symptoms or presentations ( Table 2 ) 49-54 . For example, patients with rheumatoid arthritis experience joint stiffness in the early morning, which has been correlated with enhanced serum levels of TNF and IL-6 50 .…”

24‐Hour, Weekly, and Annual Patterns in Traumatic and Non‐Traumatic Surgical Pediatric Emergencies

“…The involvement of cognitive functions may differ by their number, type, and importance between traumatic and nontraumatic PSE. For example, rhythm-related differences in painful symptoms in non-traumatic PSE must be kept in mind (Auvil-Novak et al, 1996;. Moreover, non-traumatic PSE are presumably linked to many other aspects of the temporal organization, in addition to cognitive functions.…”

Interplay between Microbes and the Circadian Clock

“…Chronic obstructive pulmonary disease and asthma show more severe exacerbation during night and early morning (Sundar et al 2015), whereas patients with rheumatoid arthritis experience the most painful joint stiffness in the morning, which is often ascribed to joint fluid viscosity, but is also associated with a peak in proinflammatory cytokine blood level at that time of the day (Gibbs and Ray 2013). On the other hand, ischemic and hemorrhagic stroke (Elliott 1998;Gupta and Shetty 2005), myocardial infarction (Cohen et al 1997;Muller et al 1997), and vaso-occlusive crisis (Auvil-Novak et al 1996) are more frequent at dawn.…”