Much to my delight, the Baltimore Ravens won the 2013 Super Bowl. While I am not a diehard fan, it’s great to see my hometown team win the big one. Naturally, a considerable number of the 108 million viewers of the big game were from Maryland.1 Unfortunately, I was not one of them. Instead, I was working for our affiliated emergency department (ED) on Super Bowl Sunday and had to rely on online updates to know what was going on. I was a bit disappointed to miss the event, but I know that, since the Ravens always lose when I watch their games, it was much better for them that I missed the game. Yes, it all depends on me.
Seriously, I was amazed at how low the study volume was at all 3 hospitals I was covering that Sunday evening. The mix of cases was about the same—a few folks with significant pathology mixed in with others with minor findings or none at all—but I estimate I read about one-third of the typical number of imaging studies for my shift. I know Christmas Day has historically been pretty quiet in the ED and so has Thanksgiving Day, to a lesser degree, but I was very impressed with the power of the Super Bowl to influence patient volume.2
I asked my wife, the Reference Librarian, to find out what other events have been found to clearly reduce average ED volumes. She found studies indicating that for 782 sporting events, including professional baseball and football, Division 1 college football and college basketball games, a mean of 18.2 patients presented to the ED during the 2 hours before, 3 hours during, and 2 hours after the games, compared to 23.3 patients during non-game times. This was significant at p < .000074.3 The rate and characteristics of ED visits were also measured before, during, and after the Olympic men’s gold medal ice hockey game. There was a 17% decrease (136 fewer patients per hour of broadcast) with p < 0001.4 The relative decrease was particularly large for adult men with low triage severity, and the decrease was most significant for patients with abdominal, musculoskeletal, and traumatic disorders.4 Pediatric ED visits and emergency surgical admissions at a Northern Ireland hospital during a televised pan-European soccer tournament showed no difference from visits/admissions on nights without such a broadcast.5 Clearly, children who complain to caregivers about health matters go to the doctor no matter what’s on television.
So what’s going on here? For one thing, people with chronic or minor problems are not going to electively come to the ED and risk missing major televised sporting events. Perhaps even some with potentially major problems are also too enthralled by the drama to tear themselves from the TV and the many amiable comrades they are bonding with to watch the manly brawl, particularly when the home team is involved. Someone suffering crushing chest pain going into the left arm can always tough it out until half-time (although even this is hard to overlook) or subjectively downplay or completely ignore the symptoms. Suppose someone at the typical Super Bowl party faints, has a seizure or hematemesis. Someone at the party certainly will notice and get help (or maybe not, since you can’t miss anything. After all, it is the Big Game). This year’s Super Bowl, with its long power outage, probably allowed for at least a cursory check of the well-being of the crowd. However, some amount of acute illness is probably just the expected background noise at a Super Bowl party. Another factor that may affect ED volume could be the potential for large amounts of alcohol to numb pain.
Whatever the specific reason, it is clear that what a person is doing at the moment has a tremendous influence on deciding how he reacts to acute health disorders or elective health matters. Face it, there are more interesting things to do than visit the emergency room, especially if it means missing the Big Game.
So, don’t fret if you’re covering emergency radiology on an important holiday or during a major entertainment event. Yes, you’ll miss the fun, but think about how quiet it will be; how it will give you a chance to bond with your colleagues in your mutual suffering and to revel in your feelings of noble self-sacrifice.
This year, I finished reading the ED studies by midnight and, sure enough, things were just beginning to heat back up. The parties were over, and the ED was now turning into a more enticing option, particularly since the postgame commentary was on the big screen in the waiting room.
I didn’t speak to the next radiologist covering the graveyard shift, but I suspect she was amazed at the unusually high volume of visitors now freed from the bondage of the famous football game to tend to their health.
Super Bowl quiets the ED. Appl Radiol.