Is circadian variation in XXXX severity relevant in the emergency department?

@entity748 @entity1 @entity1353 @entity565 @entity2613 @entity5143
STUDY OBJECTIVE: @entity748 @entity1 have marked circadian variation in disease severity, with @entity5143 far worse between midnight and 8 AM than at other times of day. In this study we sought to determine whether circadian variation in @entity565 severity is clinically relevant for purposes of emergency management. DESIGN: Prospective, observational cohort study. SETTING: The emergency department of a large urban university hospital. @entity1 : @entity748 @entity1 16 years and older who presented with the complaint of @entity565 exacerbation. RESULTS: Peak expiratory flow rate (PEFR), respiratory rate, and objective and subjective assessments of @entity1353 severity were determined at the time of each @entity1 's presentation to the @entity2613 and at the time of disposition decision. Time of symptom onset, duration of symptoms, response to therapy, and final disposition were recorded. Nocturnal presentation and onset were defined as arrival in the @entity2613 or onset of symptoms between midnight and 8 AM. We enrolled 188 @entity748 @entity1 in the study; 52 (28%) presented nocturnally. Comparison of @entity748 @entity1 who presented nocturnally and those who presented at other times revealed no differences in initial or final PEFR or respiratory rate, change in PEFR, subjective or objective @entity1353 , or rate of hospitalization, although nocturnal @entity1 did have a significantly shorter @entity2613 treatment time. Analysis by time of symptom onset also revealed no differences between nocturnally and nonnocturnally presenting subjects in disease severity or outcome, with the exception that those with nocturnal symptom onset had less subjective @entity1353 than other @entity748 @entity1 . Repeat analysis with different "nocturnal" time periods did not alter the results. CONCLUSION: In our study group, @entity748 @entity1 who presented nocturnally to the @entity2613 did not differ from other @entity748 @entity1 in disease severity and therefore do not appear to represent a unique population for purposes of @entity2613 management or disposition decisions.
