A major sporting event does not necessarily mean an increased workload for accident and emergency departments. Euro96 Group of Accident and Emergency Departments

Impact of the Soweto football derby on the trauma emergency department at Chris Hani Baragwanath Academic Hospital, a tertiary level hospital in South Africa

INTRODUCTION

The Soweto Derby is one of Africa's largest football derbies. The two rival teams, Kaizer Chiefs and Orlando Pirates, both originate in Soweto, a sprawling township 20km outside Johannesburg. Soweto is infamous for the high levels of violent crime and trauma, but also for Chris Hani Baragwanath Academic Hospital (CHBAH), with one of the world's largest trauma emergency departments (ED). Research globally, describing the impact of sports events on public health care systems is conflicting, with evidence showing both increases and decreases in spectator related trauma. This paper seeks to describe the trauma burden during the Soweto Derby and add to the research concerning trauma relating to sporting derbies in low to middle income countries.

OBJECTIVES

To analyze the impact of the Soweto Derby on the trauma ED at CHBAH over a 24-hour period.

METHODS

A retrospective comparative study at the CHBAH Trauma ED of 13 Soweto Derbies played over a 5 year period between 2015-2019, compared to the corresponding non-Soweto Derby days of the preceding year. Patients were triaged according to the South African Triage Scale and Advanced Trauma Life Support (ATLS) principles. Data was organized into 3 time frames where the triage score and mechanism of injuries were compared: 1) 4 hours pre-match, 2) 2 hours during the match, and 3) 18 hours post-match.

RESULTS

Thirteen Soweto Derbies and 2552 patients were included. The median age was 29 with males accounting for 73.4% of all trauma cases. Significantly more P1 patients presented during the Soweto Derby. Pre-match there were 3x less P1 patients presenting to the ED (4.7% vs 12%, p = 0.044). During the match, there was a 40% drop in males presenting to ED (5.95% vs 9.45%, p = 0.015). Post-match there was a significant increase in P1 patients treated (17.4% vs 13.5%, p = 0.021)), with the majority being young males. There was no increase in either female or paediatric visits to the ED.

CONCLUSION

The Soweto Derby has a direct effect on the trauma burden at CHBAH, with more P1 patients presenting post-match. Young African males are disproportionally affected by severe trauma requiring increased health care resources in an already overburdened hospital.

A retrospective multistate analysis: Do regional football games impact emergency department patient volume?

OBJECTIVE

We sought to assess the effect of National Football League (NFL) games played by a regional sports team, the New England Patriots, on emergency department (ED) patient volume.

METHODS

We conducted a multicenter, retrospective chart review at the following 3 tertiary centers in New England from 2012 to 2019: Beth Israel Deaconess Medical Center, Boston, MA; Dartmouth Hitchcock Medical Center, Lebanon, NH; and Maine Medical Center, Portland, ME.

RESULTS

Within the NFL season, we observed a 2.6% overall decrease (-10.4 patients) in average total daily volume across the study sites on Sundays when Patriots games were played compared with Sundays when games were not played (P = 0.07; 95% confidence interval [CI], -22.37 to 1.62). We observed a 4.3% reduction (-19.0 patients) in average total daily volume across the study sites on Mondays during which Patriots games were played compared with Mondays without games (P = 0.15; 95% CI, -43.51 to 5.47). Subanalyses on the 5-hour period corresponding with each Patriots game showed reductions in mean patient volume per hour. Although our primary and subanalyses showed reductions in patient volume during Patriots games, these results were not statistically significant.

CONCLUSIONS

Our data support prior studies that showed a minimal impact of major sporting events on ED patient volume at tertiary centers. These results add to the limited data on this topic and can inform administrators whether staffing adjustments are necessary during similar types of sporting events.

How do the FIFA World Cup 2018 and the 2016 UEFA championships impact a pediatric emergency department?

INTRODUCTION

In France, soccer is the most popular sport, which today attracts a huge television audience with millions of spectators in the case of international competitions. During certain games with European top clubs, the attendance of adult emergencies is impacted. However, the impact of international soccer competitions on pediatric emergency department (PED) activity has not been evaluated.

METHODS

We performed a retrospective analysis of attendance in the PED of a tertiary university hospital in Nancy (France) during the UEFA 2016 championship and the FIFA 2018 World Cup. Games were represented by 2.5-h blocks and the tournament period was compared with the same period in the previous year.

RESULTS

Considering all games, we did not observe an impact of PED attendance. The admission rate was significantly lower during the final phase (11.1 patients per match vs. 13.9, P=0.037). We observed a decrease in consultations for trauma (4.9 vs. 6.7, P=0.006). The effects were higher during games involving the national French team, with a decrease in less severe admissions (P=0.034), attendance of older children (P=0.016), and the presence of the father as accompanying adult (P=0.002). During the two final matches, we observed a decrease of 14% in the total activity.

CONCLUSION

We found significant differences in PED attendance during two international soccer tournaments. It would be interesting to study this effect in countries other than France or in countries with different sport habits.

How the COVID-19 pandemic is affecting paediatric orthopaedics practice: a preliminary report

PURPOSE

Since the state of alarm was decreed in Spain on 14 March 2020, the coronavirus disease 2019 (COVID-19) pandemic has had an extraordinary impact in paediatric hospitals. This study shows the effect of the pandemic on our practice in paediatric orthopaedics in a referral third level paediatric hospital.

METHODS

We performed a single-centre retrospective review of the official census from a third level paediatric hospital from 14 March to 14 April for the years 2018, 2019 and 2020.

RESULTS

The patients seen in our clinic during this period in 2020 decreased in by 82% (p < 0.001) compared with 2018 and 2019, however, the number of telemedicine consultations increased by 90.21% (p < 0.001). The total number of patients attending the clinic (including onsite and virtual) was reduced by 54.25% (p < 0.001). The total surgeries performed plummeted by 81% in this period in 2020 (p < 0.001) due to a reduction in elective cases of 94.6% (p < 0.001). No significant decrease was found in the number of urgent surgical cases per day in 2020 (p = 0.34). Finally, the number of orthopaedic patients admitted to our emergency department dropped by 78.6% during the state of alarm (p < 0.001).

CONCLUSION

According to our results, the pandemic has significantly affected our daily practice by decreasing elective surgeries and onsite clinics, but other activities have increased. As we have implemented telemedicine and new technologies to adapt to this setback, we should take advantage of the situation to change our practice in the future to better allocate our health resources and to anticipate outbreaks.

Published without peer review.

LEVEL OF EVIDENCE

IV.

Admission rates in emergency departments in Geneva during tennis broadcasting: a retrospective study

Background

Literature provides mixed results regarding the influence of large-scale sporting events on emergency department attendance. To contribute to the research on the subject, we sought to evaluate whether the broadcasting of major tennis tournaments, one of the most popular sports in Switzerland, has an impact on patient admission rates in emergency units in Geneva including 1) type of match 2) the role of a Swiss player, 3) degree of triage, 4) reason of attendance and 5) age of patients.

Methods

Admission rates between periods with tennis matches regarding the semi-finals and finals of 3 major tennis tournaments were compared to equivalent periods without matches from May 2013 to August 2017. Patient admission data was retrieved retrospectively from administrative databases of two Outpatient Emergency Units in Geneva. Patients’ admission rates in periods with and without a tennis match were investigated using a negative binomial regression model with mixed effects.

Results

We observed a statistically significant decrease (− 10%, 95% CI -17 to − 2, p = 0.015) in admission rates in periods with a tennis match compared to periods without a tennis match, more pronounced during finals (− 15%, 95% CI -26 to − 3, p = 0.017) than during semi-finals (− 7%, − 16 to 2, p = 0.13). In addition, this effect was more pronounced in patients aged between 26 to 64 years of age, a category representing professionnally active people. No modification in the admission rates was detected in the hours preceding and following the matches, nor in type of consultations (traumatology vs non traumatology related admissions).

Conclusion

Although modest, the results support the hypothesis that the broadcasting of large-scale sporting events such as tennis matches decreases admission rates in emergency units. Further research is required to explore for a potential causal relationship.

Electronic supplementary material

The online version of this article (10.1186/s12873-018-0209-y) contains supplementary material, which is available to authorized users.

The influence of a major sporting event upon emergency department attendances; A retrospective cross-national European study

Major sporting events may influence attendance levels at hospital emergency departments (ED). Previous research has focussed on the impact of single games, or wins/losses for specific teams/countries, limiting wider generalisations. Here we explore the impact of the Euro 2016 football championships on ED attendances across four participating nations (England, France, Northern Ireland, Wales), using a single methodology. Match days were found to have no significant impact upon daily ED attendances levels. Focussing upon hourly attendances, ED attendances across all countries in the four hour pre-match period were statistically significantly lower than would be expected (OR 0.97, 95% CI 0.94-0.99) and further reduced during matches (OR 0.94, 95% CI 0.91-0.97). In the 4 hour post-match period there was no significant increase in attendances (OR 1.01, 95% CI 0.99-1.04). However, these impacts were highly variable between individual matches: for example in the 4 hour period following the final, involving France, the number of ED attendances in France increased significantly (OR 1.27, 95% CI 1.13-1.42). Overall our results indicate relatively small impacts of major sporting events upon ED attendances. The heterogeneity observed makes it difficult for health providers to predict how major sporting events may affect ED attendances but supports the future development of compatible systems in different countries to support cross-border public health surveillance.

The Impact of an Extreme Sports Event on a District General Hospital

Background: Extreme sports events are increasing in popularity, particularly in mountainous areas throughout Great Britain. Emergency medical care for these events is usually provided by voluntary organisations, providing event side first aid and referring patients to nearby District General Hospitals. The Fort William Mountain Bike Race is part of the UCI World Cup Series: 173 competitors racing in cross country, downhill and 4X events. The Belford Hospital provides year round medical care for the Lochaber community, which frequently swells during the tourist season. The hospital has 8300 new attendances per annum, 35 patient reviews per 24 hrs. Methods and Results: We have reviewed the impact of the event on the local hospital. In total 52 riders reported 61 injuries. The hospital treated 24 (14%) riders. Retrospective analysis of attendances has revealed 19 riders attended on race days, increasing attendees by up to 28%, 46% of injured riders were seen at the A&E department, 1 rider requiring admission for observation and 1 rider required inter-hospital transfer. Injury patterns (knee 20%, hand/wrist 18% & shoulder 18%) were similar to other reported series. Conclusions: We believe that extreme sports events can have considerable impact on small district general hospitals. Additional triage and staffing resources should be utilised and event organisers should anticipate the additional problems they present to the local community. District General Hospitals continue to provide a substantial contribution to the provision of health care for extreme sports within the UK.

Emergency department presentations during the State of Origin rugby league series: a retrospective statewide analysis

OBJECTIVE

To evaluate the effect of the State of Origin rugby league series on the number of emergency department (ED) presentations in Queensland.

DESIGN AND SETTING

Retrospective analysis of Emergency Department Information System data from 25 Queensland EDs for game 10s and matched control 10s during the annual State of Origin series from 2005 to 2012. The Queensland team won seven of the eight series in this period.

MAIN OUTCOME MEASURES

Number of patients presenting to Queensland EDs on 24 game 10s and 80 control 10s.

RESULTS

Proportionally, a binomial test indicated there were significantly fewer ED presentations on game 10s (49,702) than on control 10s (172,351) (P<0.001). On average, there were 2,154 presentations per 10 on control 10s and 2,071 on game 10s, representing a 4% reduction on game 10s.

CONCLUSION

We found that the State of Origin series was associated with fewer ED presentations on game 10s. We believe these results have broader implications for workforce planning and resource allocation.

Pediatric emergency department census during major sporting events

OBJECTIVES

Our study attempted to evaluate the effects of major sporting events on the census of a pediatric emergency department (ED) in the United States specifically related to the National Football League Super Bowl, National Basketball Association (NBA) Finals, and Major League Baseball World Series.

METHODS

We performed a retrospective data analysis of our pediatric ED census on the number of visits during major sporting events over a 5-year period. Data during the same period 1 week after the major sporting event were collected for comparison as the control. We evaluated the medians of 2-hour increments around the event start time. Subgroup analysis was performed for games involving the local sporting teams.

RESULTS

Our results showed no significant difference in ED census during the sporting events, except in the post 6 to 8 hours of the NBA finals. Subgroup analysis of the Los Angeles Lakers showed the same significant findings in the post 6 to 8 hours of the NBA finals.

CONCLUSIONS

No major difference in pediatric ED census is observed during the most major sporting events in the United States.

Emergency department visits during an Olympic gold medal television broadcast

BACKGROUND

Practice pattern variations are often attributed to physician decision-making with no accounting for patient preferences.

OBJECTIVE

To test whether a mass media television broadcast unrelated to health was associated with changes in the rate and characteristics of visits for acute emergency care.

DESIGN

Time-series analysis of emergency department visits for any reason.

SUBJECTS

Population-based sample of all patients seeking emergency care in Ontario, Canada.

MEASURES

The broadcast day was defined as the Olympic men's gold medal ice hockey game final. The control days were defined as the 6 Sundays before and after the broadcast day.

RESULTS

A total of 99 447 visits occurred over the 7 Sundays, of which 13 990 occurred on the broadcast day. Comparing the broadcast day with control days, we found no significant difference in the hourly rate of visits before the broadcast (544 vs 537, p = 0.41) or after the broadcast (647 vs 639, p = 0.55). In contrast, we observed a significant reduction in hourly rate of visits during the broadcast (647 vs 783, p < 0.001), equal to an absolute decrease of 409 patients, a relative decrease of 17% (95% confidence interval 13-21), or about 136 fewer patients per hour. The relative decrease during the broadcast was particularly large for adult men with low triage severity. The greatest reductions were for patients with abdominal, musculoskeletal or traumatic disorders.

CONCLUSION

Mass media television broadcasts can influence patient preferences and thereby lead to a decrease in emergency department visits.

The effect of sporting events on emergency department attendance rates in a district general hospital in Northern Ireland

BACKGROUND

Previous studies have reported a conflicting relationship between the effect of live and televised sporting events on attendance rates to emergency departments (ED). The objectives of this study were to investigate the relationship of major sporting events on emergency department attendance rates and to determine the potential effects of such events on service provision.

METHODS

A retrospective analysis of ED attendances to a district general hospital (DGH) and subsequent admissions over a 24-h period following live and televised sporting activities was performed over a 5-year period. Data were compiled from the hospital's emergency record books including the number of attendances, patient demographics, clinical complaint and outcome. Review patients were excluded. Analysis of sporting events was compiled for live local, regional and national events as well as world-wide televised sporting broadcasts.

RESULTS

A total of 137,668 (80,445 men) patients attended from April 2002 to July 2007. Mean attendance rate per day was 80 patients (men = 47). Mean admission rate was 13.6 patients per day. Major sporting events during the study period included; Soccer: 4 FA Cup and 1 World Cup (WC) finals; Rugby: 47 Six Nations, 25 Six nations games involving Ireland, 1 WC final, 2 WC semi-finals, 2 WC quarter-finals and 4 WC games involving Ireland; and Gaelic Football [Gaelic Athletic Association (GAA)]: 5 All-Ireland finals, 11 semi-finals, 11 quarter-finals and 5 provincial finals. There was a significantly higher patient admission rate during the soccer FA Cup final, Rugby Six Nations and games involving Ireland and for GAA semi- and quarter-final games (p = 0.001-0.01). There was no difference identified in total attendance or non-admission rates for sporting events throughout the study period. Although there was no correlation identified between any of these sporting events and total emergency department attendances (r < 0.15, p > 0.07), multinomial logistic regression demonstrated that FA Cup final (p = 0.001), Rugby Six Nations (p = 0.019), Rugby WC games involving Ireland (p = 0.003), GAA All-Ireland semi- and quarter-finals (p = 0.016; p = 0.016) were predictors of patient admission rates.

CONCLUSION

This study suggests that live or televised sporting events do not significantly affect ED attendances to a DGH. However, some events appeared to be predictors of patient admission rates. Although it may be beneficial to consider the effect of sporting events on service stratification during these periods, the overall effect is probably minimal and should not create a major concern for future service provision despite the implementation of the European Working Time Directive.

Can sports events affect suicidal behavior? A review of the literature and implications for prevention

BACKGROUND

Engagement in sports and physical activity, either actively as an athlete or in a passive way as a spectator, impacts interpersonal behavior and physical and mental health.

AIMS

The study reviews literature on the relationship between sports spectatorship and suicidal behavior to ascertain whether sports spectatorship has an impact on suicidal behavior, either increasing the risk or being a protective factor.

METHODS

The literature was searched via PubMed/MEDLINE and PsycINFO. Nine studies published between 1986 and 2006 were identified.

RESULTS

The reviewed studies focused on the impact of sports events on the societal level, and analyzed data regarding national or local suicide rates. Their results indicate that sports events can have an impact on suicide mortality and morbidity, but this relationship seems to be mediated by age, gender, marital status, and alcohol consumption, as well as the process and outcome of the game (e.g., victory vs. defeat of the favored team).

CONCLUSIONS

There is some evidence that sports events can reduce the rates of suicide on the societal level; however, there is a lack of studies exploring how sports spectatorship might influence levels of suicide risk in individuals and how mediating variables might operate on the individual level.

Were attendances to accident and emergency departments in England and Australia influenced by the Rugby World Cup Final 2003?

OBJECTIVES

To determine changes in volume and timing of accident and emergency (A&E) attendances associated with the Rugby World Cup Final 2003.

METHODS

Retrospective analysis of A&E attendance data from the West Midlands Surveillance Centre and the New South Wales Emergency Department Collection.

SETTING

West Midlands, England and New South Wales, Australia.

MAIN OUTCOME MEASURES

Relative risk of accident and emergency attendance during a 18-h period in 2003 compared with the same 18-h period in the years 2000-2002.

RESULTS

In the West Midlands, in the 2 h before kick-off there were 72 attendances compared with an expected 101 in 2000-2002 [relative risk (RR) 0.71, 95% confidence interval (CI) 0.55-0.89]. For New South Wales, there were 326 attendances compared with an expected 384 (RR 0.85, 95% CI 0.76-0.95). The West Midlands saw a significant increase in attendance peaking 6-8 h after the kick-off (RR 1.27, 95% CI 1.10-1.46).

CONCLUSION

In the West Midlands, it appears that attendance was reduced in the hours immediately surrounding the final, but in subsequent hours attendances increased, potentially as a result of celebration of the win. In New South Wales, the final was associated with reduced attendance in the hours leading up to the final, but they quickly returned to normal. Major sporting events can influence accident and emergency workload.

Hospital-based healthcare provider (nurse and physician) integration into an emergency medical services–managed mass-gathering event

INTRODUCTION

This report describes not only the implementation of a coordinated emergency medical services-hospital-based healthcare team but also investigates the integration of nurse-physician teams at a mass gathering medical care event.

METHODS

A review of resource utilization, patient encounters, and local ED census was performed during this period at a college football stadium.

RESULTS

During this 4-year period, 1681 patients presented for medical care during 26 events with a total attendance of 1,544,244 (1.09 patients per thousand attendees [PT]). The majority of patient contacts were for minor complaints (1451, 87.6%), whereas 205 (12.4%) received full evaluations (focused history and physical examination most often with pulse oximetric and electrocardiographic monitoring). A total of 109 patients were transported (4.19 PT), representing 6.48% of all patients. Patient census for the event medical deployment increased from 0.44 PT in 2001 to 1.75 PT in 2004. The number and percent of patients transported also increased between 2001 (0.02 PT, 4.48%) and 2004 (0.12 PT, 6.67%). However, 118 (57.6%) patients who received full evaluations were able to be discharged by a physician, avoiding transport. Chief complaints and management of patients receiving full evaluations were consistent across this period, with altered mental status (52.7%) and chest pain (12.7%) as the most common complaints. Average ED census during this period was found to be significantly higher on event days (176.2) than nonevent days (161.2) (t = 8.04, P < .001), although this produced only a minor impact on the emergent care system.

CONCLUSION

This study describes one potential deployment plan for a mass gathering medical event and suggests that the incorporation of physicians into a mass gathering setting may be associated with an absolute increase in patient census and transports, while decreasing the percent of patients transported. The impact on local emergency medical services and ED resources, although not specifically investigated in this study, was likely minimal.

Mass-gathering medical care: a review of the literature

Mass-gatherings events provide a difficult setting for which to plan an appropriate emergency medical response. Many of the variables that affect the level and types of medical needs, have not been fully researched. This review examines these variables.

METHODS

An extensive review was conducted using the computerized databases Medline and Healthstar from 1977 through May 2002. Articles selected contained information pertaining to mass-gathering variables. These articles were read, abstracted, analyzed, and compiled.

RESULTS

Multiple variables are present during a mass gathering, and they interact in complex and dynamic ways. The interaction of these variables contributes to the number of patients treated at an event (medical usage rate) as well as the observed injury patterns. Important variables include weather, event type, event duration, age, crowd mood and density, attendance, and alcohol and drug use.

CONCLUSIONS

Developing an understanding of the variables associated with mass gatherings should be the first step for event planners. After these variables are considered, a thorough needs analysis can be performed and resource allocation can be based on objective data.