There is exciting news in emergency medicine today that has apparently just been released by Boston Children's Hospital. The news tickles baseball fans too, especially Red Sox fans. It seems that emergency room visits decrease during riveting baseball games and increase during not so interesting games. According to the buzz, as many as 15% more people show up in the emergency departments of hospitals during boring games and 15% fewer people show up during riveting games. So says all the news. Let's have a closer look by going directly to the journal; first- where and when was the research published?
- The Boston Globe reports that the news comes from "a study published Monday in the Annals of Emergency Medicine.
- Other sources report a journal name that is strikingly similar but different. Both the New England News and Eyewitness News say; "The study appears in today's edition of the journal Annals of Emergency Room Medicine." (too much "ER"?)
- Another news outlet suggests that it isn't a research report per se that we should look for, nor is it published today, and the journal in question is neither of the aforementioned titles. Med Page Today (now with registration) notes that the results are presented as "a letter published in the October journal "Annals of Internal Medicine."
- Forbes also has the publication date as October but says that the authors are "reporting in a letter to the editor of the October issue of the Annals of Emergency Medicine..."
- Likewise, this is what the Boston Herald reports, however they are non-committal about the form of the research; "The findings will appear in next month's Annals of Emergency Medicine."
- Live Science plays it safe by listing no journal whatsoever.
- At least the publication Medical News Today helpfully provides a link: "You can read about this study in the October issue of Annals of Emergency Medicine". However the link takes you to the September issue and from there you can find some "teaser" October articles, none of which are this study, and as an aside the medical journal notes slyly that those articles will not even necessarily appear in the October issue.
So the study either appears in "today's" ("Monday's" as some vaguely reported it) or "next month's ("October's"), issues of either the Annals of Emergency Medicine, the Annals of Emergency Room Medicine (which is either non-existent or extraordinarily elusive), or the Annals of Internal Medicine. Maybe as a break from tradition the study will appear in all three places...or no place at all. The results are published either as a "research study", a "letter", or a "letter to the editor". Though two of the journals exist, we didn't find an accessible published article of any form. The only article we accessed was a press release here, that has some of the information propagated by many of the media sources and we're unclear as to where they're getting the spurious facts.
What sort of study did the authors (Brownstein, Reis and Mandl) conduct that warrants headline coverage in at least 82 (at last count) news outlets?
- Apparently "The researchers got data from the....Automated Epidemiological Geotemporal Integrated Surveillance system, or AEGIS, which is a disease-monitoring system that has been expanded for use by the Massachusetts Department of Public Health, [that] analyzes patient data anonymously and compares it with data from previous medical visits...."
- Or, as another source puts it, they were; "[b]orrowing data from a real-time disease surveillance system developed at Children's.."
- ABC's explanation is more simply put; the researchers "compared Neilsen television ratings with hospital traffic."
- But don't underestimate the amount of work this was...."After a week of late nights crunching and plotting data for the hours in question, Brownstein and Reis..."
We wonder, AEGIS sounds like sophisticated equipment, it must perform precise parsing. After all it was developed to assist in identifying infectious disease outbreaks. Surely the authors must have "crunched" some sophisticated results and have developed an interesting discussion from the data? Actually co-author John S. Brownstein reports slightly disappointingly: "We didn't look at reasons why people were coming in for care, we just looked at the numbers -- and the numbers dropped..."
So is it far-fetched to imagine -- we do our best to check facts but we're slightly in the lurch since we have only these disparate news reports at our disposal -- that despite the power of "AEGIS", we might have generated the same conclusion by standing at the emergency room entrance with a little clicker like they do(did) for crowd control at the ball games?
The authors cumulated the data from six hospitals (and rest assured, none of the hospitals was Mass General, that seems a stone's throw away Fenway's traffic nightmares) The authors note that only in the most dramatic events, like Game 7 of the ALCS against St. Louis, or to use another example - September 11th - will such effects be noticed. Other series games only generated a 5% difference, "slight" - as very few news agencies forthrightly reported. Apparently the reason the media is so enthusiastic about this...press release...is because:
- "Although previous studies have found a decline in health-care use during major sporting events, the Children's researchers are the first to quantify the magnitude of the events"
- As well, said study leader Kenneth Mandl; "These studies suggest that the timing of ED [Emergency Department] utilization has a strong discretionary component' "
- Finally; "The scientists say that this is the first study to illustrate a direct dose-response relationship between the popularity of a sporting event and decreased use of hospital ERs."
"Dose-response!?" Number of people in Emergency Rooms v. Number of People watching TV? (Aren't we striving to move away from this?) The study seems to be misrepresented and overblown by many media sources.
Although the press release notes that; "Previous studies had suggested a relationship between important sporting events such as the Super Bowl and hospital visits", the release wasn't explicit about previous research. Clearly, despite the coverage and interest, this isn't the most pressing issue for emergency medicine.
Nevertheless, some groups have published studies in this area. Similiar less quantified results were published by the Journal of Emergency Medicine in January-February 1994, in a study by NT Reich et al titled; "The Impact of a Major Televised Sporting Event on Emergency Department Census." Different studies showed that the percentage of total emergency room visits was often more sports related during major events -- trauma/alchohol related -- at least in Ireland. Mattick et al published in the Irish Medical Journal, March, 2003, titled; "The Football World Cup 2002 - Analysis of Related Attendances To An Irish Emergency Department."
We can't compare the studies, different though they might be, because we don't have access to the current or future published study. It seems most likely that the results will appear in some form in the Annals of Emergency Medicine and we'll suspend further judgement until we perhaps see it.