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= 0.45), significant 0.45), = p Most of the follow 1 p = 0,45), significativo . p = 0.05) in less urgent admissions (triage although in some of these studies the find- 1 2-8 In contrast, one single study carried out in Spain found an increase in attendances during football match. It is ever how- noteworthy that this last study was conducted in an extra-hospital ED based in a rural area, as opposed to the ing research performed on other countries pointed to similar to pointed countries other on performed research ing conclusions, ings were limited to a statistically non-significant trend. broadcasts. This decline was more pronounced when the local team was one of the competitors. ropical. Lisboa. Portugal. T p = 0,05) apenas nas admissões menos urgentes (categorias verde- 700 - - - p = 0,05). , Matteo BOATTINI 3 The Netherlands. Copyright © Ordem dos Médicos 2014 p = 0.05). , Jaime ALMEIDA , Jaime 2 R e v i s t a C i e n t í fi c a d a O r d e m d o s M é d i c o s w w w. a c t a m e d i c a p o r t u g u e s a . c o m Serviço de Urgência Hospitalar; Triagem; Desporto; Futebol; Portugal. Desporto; Futebol; Triagem; Serviço de Urgência Hospitalar; , Mónica EUSÉBIO 1 During major sports events an overall decrease in emergency department admissions seems to take place, especially Está descrita a ocorrência de variações nas admissões ao serviço de urgência como resultado de eventos desportivos

Large sporting events have the notorious capacity of at of capacity notorious the have events sporting Large sequentes um aumento das mesmas. Estas variações só foram significativas nas categorias de triagem verde-azul. sequentes um aumento das mesmas. Estas variações só foram significativas nas categorias Conclusão: Durante eventos desportivos importantes parece dar-se uma redução nas admissões ao serviço de urgência, sobretudo devido a uma diminuição das visitas associadas a situações menos graves. Palavras-chave: Introdução: importantes. O estudo que apresentamos avaliou mudanças no volume e tipo de visitas a um serviço de urgência central de Lisboa durante e após o derby futebolístico da cidade. Material e Métodos: Analisámos retrospectivamente o volume de admissões e a como assim categoria jogos, dos antes minutos 45 de início com horas 24 de urgência períodos a relativos dados Recolhemos atribuída 2011. pela a 2008 de Triagem Manchester, de os Organizaram-se controlo. para anteriores, anos dos correspondentes semana da dias nos semelhantes períodos a relativos dados e categoria de urgência, após o que se emparelharam. dados por espaços temporais (durante e pós-jogo) Analisaram-se 14 Resultados: períodos (sete com jogo e sete sem jogo) e um total de 5861 admissões. Durante o jogo verificou-se de Triagem da categorias das sub-análise Na controlo. dias aos face admissões de total número no 0,06) = (p 20,6% de redução uma Manchester a redução foi estatisticamente significativa (26,5%; azul). Comparado com o controlo, o pós-jogo mostrou um aumento global do número de admissões somente quando consideradas as menos urgentes (18,9%; (5,6%; Discussão: Durante os jogos o número total de admissões ao serviço de urgência sofreu um decréscimo, ocorrendo nas horas sub Variations in emergency Background: department Variations admissions have been reported to happen as a result of major sports events. The work presented assessed changes in volume and urgency level of visits to a major Emergency Department in Lisbon during and after football derby. the city’s retrospec were System, Triage Manchester the to according level, urgency patient and attendances of Volume Material and Methods: tively analyzed for the 2008-2011 period. tively Data analyzed regarding for 24-hour the periods 2008-2011 starting 45 minutes before was kick-off collected, along with data from similar periods on the corresponding weekdays in the previous years, to be used as controls. Data samples were organized match), urgency level, and paired accordingly according to time frame (during and after the During admissions. 5861 of total a to corresponding analyzed, were non-match) 7 and match (7 periods relevant 14 of total A Results: the match time frame, a 20.6% reduction (p = 0.06) in the total number of attendances was found when compared to non-match days. MTS urgency level sub-analysis only showed a statistically significant reduction (26.5%; (5.6%; admissions in increase global a showed frames time post-match controls, to Compared green-blue). levels only when considering less urgent ones (18.9%; subse a by followed matches, the during occurred attendances department emergency of number total the in decrease A Discussion: These variations only reached significance among visits triaged green-blue. quent increase in the following hours. Conclusion: conditions. due to a drop in visits associated with less severe Sports; Soccer; Portugal. Triage; Keywords: Emergency Service, Hospital;

Admissions the Profile of Emergency Department Department Emergency of the Profile

O Impacto do Derby de Futebol Lisboeta no Perfil de Admissões a um Admissões no Perfil de Derby de Futebol Lisboeta O Impacto do Serviço de Urgência The Impact of the Lisbon Football Derby on Derby Football the Lisbon Impact of The ABSTRACT 1. Unidade Funcional de Medicina 4. Centro Hospitalar de Lisboa Central. Lisboa. Portugal. 2. Unidade de Saúde Pública Internacional e Bioestatística. Instituto de Higiene e Medicina 3. Department of Neuroscience. Erasmus MC University Hospital. Rotterdam. INTRODUCTION Recebido: 08 de Novembro de 2013 - Aceite: 26 de Março de 2014 | Recebido: 08 de Novembro de 2013 - RESUMO André ALMEIDA André Acta Med Port 2014 Nov-Dec;27(6):700-703 tracting large crowds into match venues as well as draw ing the attention of many to view live televised broadcasts. Studies analyzing the impact of these events on the - num ber and type of emergency department (ED) attendances in several countries with a developed health care system cov study, such major first The results. mixed yielded have American Football Super Bowl finals from 1988 to ering the 1992, found a significant decrease in attendances during

ARTIGO ORIGINAL est increase in volume of admissions. of volume in increase est mod- a showing few a with events, match following hours concerned, usingaquantifiablemeasure. such study was ever is conducted level urgency in as far Portugal. as variations these Besides, by affected most admissions of type the in focused works cited the of none place. took tions investiga former the of most where setting hospital urban of categories 1-3 (red-yellow: resuscitation, emergent and subset emergent resuscitation, a (red-yellow: in 1-3 categories MTS of the by assigned as levels triage the to according grouped were numbers Admission control). for on the last Saturday in November 2010 would be considered last the on Saturday in November 2011, place data related to a taking similar period match a after and during period 24-hour a for (Example: controls. day) (regular non-match as used was year, previous the in weekday corresponding related to intervals of the same Post- length, similar day time and whistle. final expected Data hours. 20.5 following the spanned frames time match the after minutes 45 extra-time, and and (90 break time half-time for match minutes 30 regular minutes), whole kick-off, before minutes 45 comprising extent, 3.5-hour a frames. had frames time time post-match Match and match into divided further were which each, hours 24 of duration total a had studied Statistics which the afore-mentioned matches took place. Hospital’s The periods digital in stored retrospective the period, a 2008-2011analysis, directed at gathering admission the data to for periods in from subjected by data was data This provided Department. was records, MATERIAL AND METHODS days. ‘regular’ was any variation in these figures between match days and goal was to monitor patient admission numbers and Sporting after and during ED this in presentations clinical of severity presented atadmission. problems on based symptoms use and signs the of flow-charts of through system, nurse-operated a to according stratified are levels These the visits. patient rank of level to urgency world, the around centers emergency many in employed is MTS The use. in is (MTS) System Triage and northeastern districts. In São José’s ED the Manchester eastern Lisbon’s with alongside centre historical city’s the major a tertiary care in centre, its integrated catchment area is encompassing ED This centre. city Lisbon’s in located ED, adult Hospital José’s São to admissions of pattern the We on event sports audience. popular this of impact the assess to aimed television and encounter turn-out League public First highest Portuguese the twice-yearly with event sporting regular main city’s the is Benfica, S.L. and C.P. Sporting clubs football major Lisbon’s between some geographicalandculturalcontexts. in expressive be might which phenomenon a violence, and misuse alcohol to related casualties in rise a to due as well as duration match during delayed been had which visits of effect rebound a to due being as authors the by explained Almeida A, etal. The impactoftheLisbonfootballderbyonprofileemergencydepartmentadmissions, ED Our The No . Benfica matches, in order to determine if there if determine to order in matches, Benfica vs. 9 Some studies have also focused on the on focused also have studies Some 13 ica da Ordem dos Médicos www m o c . a s e u g u t r o p a c i d e m a t c a w. w w s o c i d é M s o d m e d r O a d a c fi í t n e i C a t s i v e R 3-4,12 4,10-12 This increase is increase This - 701 and 6.4 km from the two stadiums where the matches take matches the where stadiums two the from km 6.4 and km 6.2 approximately located is ED our as and coverage, TV live had matches all venues. As sports and stadiums in ofpublic presence physical through profile admission the on determinant sole the being proximity of possibility the admissions perhour(9.7%, as red-yellow (categories 1-3) the mean difference was -0.8 26.5%; of reduction (a -2.1 was 4-5) (categories green-blue as triaged hour per admissions in difference mean the days, match On 0.06). (p = intervals control from admissions in a reduction 20.6% represents difference This hour. per admitted patients 17.7 and 14.1 of average an to respectively corresponding the ED, compared to 435 during respective control intervals, ttsia Cmuig Ven, uti 2011). Austria for Vienna, Foundation Computing, (R Statistical samples paired for test using Wilcoxon analyzed the then was triage data of The number admissions. in subsets and admissions, total of number in both other, each with paired were samples day non-match blue: urgent and non-urgent). Match day and corresponding (green- 4-5 categories of subset another and urgent) very match time fram physicians. (Table 1) ED by arranged consultations reevaluation for admitted or teams vehicle outreach emergency by syndrome coronary MTS. the acute for admitted directly either were patients with triaged Non triaged were 4582 these, Of 5681 of admissions. total a comprising scrutinized, non- was 7 days) and match days League match (7 periods First relevant 14 Portuguese of total A 7 television. of on live broadcast were total and Lisbon in stadiums a were matches these took place of in either one All of the research. two respective our home of object the was which period 4-year the during Sporting and Benfica between matches drop in geographical admissions event. distant phenomenon sports actual has and the been of close proximity described in ED’s in both occur to events. sporting to a decline in the demand for emergency care during major pointing evidence, published of most with concur to seem RESULTS relevance wasconsideredfor concerned. such events, at least as far as less severe presentations are follow that hours the in demand this in increase ensuing an DISCUSSION levels red-yellow. (Fig.1) (2%; +0.02 of difference average an triage per hour occurred in levels green-blue (18.9% to according admissions admissions +1.4 of difference average an subset, category these of break-up the 5.6%; of to increase compared (an controls hour, during 116.3 per ED the attending patients 122.8 During There This Although During time frames, there were on average on were there frames, time post-match bearing modest significance, our findings our significance, modest bearing 1-8 Furthermore, it suggests there might be might there suggests it Furthermore, = 0.05), while for admissions triaged admissions for while 0.05), = p Acta MedPort2014Nov-Dec;27(6):700-703 es a total of 345 patients attended p =0.55). p valuesbelow0.1. 2,4-8 = 0.80) occurred in occurred 0.80) = p This fact rules out rules fact This p p =0.05) and 14 04) In 0.44). = Statistical

ARTIGO ORIGINAL

297 366 334 320 316 303 367 338 359 412 458 324 360 337 Total 2517 2384 Control days Match days n / hour). 8 17 23 42 15 16 13 24 24 16 21 34 37 19 197 122 Not triaged 4-5 129 124 148 147 143 167 235 149 175 191 255 173 148 189 1084 1289 Acta Med Port 2014 Nov-Dec;27(6):700-703 Port 2014 Acta Med Categories Categories 4-5 1-3 117 151 219 144 158 157 123 124 165 160 205 182 175 129 1103 1106 Post-match Time Frame Post-match Time Triage Urgency Levels Triage Categories n = 5861). Categories 1-3 are MTS levels red-yellow and 4-5 Post-match Time Frame Time Post-match Categories 1-3 40 56 62 56 39 66 39 80 50 54 58 79 44 57 435 345 Total 702

9 8 7 6 5 10 Admissions/hour 1 3 0 3 1 1 0 4 2 1 1 5 0 0 10 22 Not triaged 10 25 31 20 15 32 17 41 25 25 26 36 17 20 4-5 144 196 Categories Categories 4-5 R e v i s t a C i e n t í fi c a d a O r d e m d o s M é d i c o s w w w. a c t a m e d i c a p o r t u g u e s a . c o m 29 28 31 33 23 33 22 35 23 28 31 33 27 37 1-3 196 217 Categories Match Time Frame Match Time Match Time Frame Time Match Triage Urgency Levels Triage Categories 1-3

9 8 7 6 5 10 Admissions/hour Control day 7 Match day 7 Match day 6 Control day 6 Control day 5 Match day 5 Control day 4 Match day 4 Match day 3 Control day 3 Control day 2 Match day 2 Match days Control day 1 Triage Urgency Level Control days Match day 1 Almeida A, et al. The impact of the Lisbon football derby on the profile of emergency department admissions, admissions, department of emergency the profile derby on Lisbon football impact of the The A, et al. Almeida - Variation in number of Emergency Department admissions per hour during match and post-match time frames ( Figure 1 - Variation Categories 1-3 are MTS levels red-yellow and 4-5 are green-blue. Table 1 - Number of admissions during match and post-match time frames ( Table are green-blue.

ARTIGO ORIGINAL and post-matchtime. pre immediate the in admissions potential minimized have red-yellow). In fact, for both time intervals, it was the only the was it intervals, time levels both for fact, (triage In red-yellow). patients urgent more green- by visits levels in observed (triage ones the patients than pronounced more urgent considerably were blue) less by visits in marker, showing that the decline and subsequent increment this of use the by study our in strengthened and reiterated are co-workers and author afore-mentioned the of findings of presenting score patients’ stratification severity previous to their medical assessment. The objective an as levels MTS study,used our we In records. clinical of appreciation retrospective a in albeit account, into taken was conditions suy oue o oe set etrd n Miró’s in featured aspect one on focuses study works, in theassessmentofpatients’ clinicalseverity. MTS the interpreting stratified when results, as this system taken might not be entirely reliable be must care Finally, described. place impact the minimizing taken thus days, control during have could sports, both to events, unrelated and televised related and live popular Also, numbers. could have been responsible for variations in the admission which conditions, environmental other or weather as such circumstances used confounding by days distorted been control have could and match in both ED Furthermore, our constraint in 2007. implemented unavoidable fully only was an MTS the years), since (4 analyzed period ED. our to referred not were events, sporting major during higher be to in settings alcohol- some described are with which aggressions, namely and injuries spectators, related live involving events that possible is it venues, both to closer Hospital) Maria’s (Santa department emergency major another to ourED. is there As ofvisits pattern the in influence an had have could viewing television and presence stadium both place, 9. 8. 7. 6. 5. 4. 3. 2. 1. REFERENCES Almeida A, etal. The impactoftheLisbonfootballderbyonprofileemergencydepartmentadmissions,

This Limitations ee-iri I Ctln ao , aaan ioa F Barriendo F, Nicolay Zalacain F, Fabo Catalan I, Perez-Ciordia Olympic goldmedaltelevisionbroadcast. OpenMed.2011;5:e112-9. Redelmeier DA, Vermeulen MJ. Emergency department visits during an emergency departmentattendances.Eur JEmergMed.2009;16:58. events?) sport other and (... Rugby and Football M. Sanchez O, Miro services. MedClin.2000;114:538-9. Miro O, Sanchez M, Borras A, Milla J. Football, television and emergency European Football Associations. EurJEmergMed.2002;9:77. football television of Union live departments? emergency and accident does at attendances affect League: Champions UEFA SH. Boyce Rugby World CupFinal2003?EurJEmergMed.2007;14:68-71. and emergency departments in England and Australia influenced by the accident to attendances Were D. Muscatello RG, Hendry WE, Moody Calid Rev times. convenient Asist. 2012;27:123-4. at rooms football emergency how of or use circenses the et shows Panem N. Gimenez J, Pico A, Arevalo 2010;64:1563-9. Pract. Clin J Int Ireland. Northern in attendance hospital general district department a in emergency rates on events sporting of effect The Med. Emerg McGreevy A, Millar L, Murphy B, Davison GW, Brown R, O’Donnell ME. J census. department 1994;12:15-7. emergency on event sporting Reich NT, Moscati R, Jehle D, Ciotoli M. The impact of a major televised 6-7 hrb te eeiy f ains presenting patients’ of severity the whereby f u suy nld te eaiey short relatively the include study our of ica da Ordem dos Médicos www m o c . a s e u g u t r o p a c i d e m a t c a w. w w s o c i d é M s o d m e d r O a d a c fi í t n e i C a t s i v e R 10-12 ec, hs atr could factor this Hence, 15 703 CONCLUSIONS and capabilitiesofdifferent healthservices. play a role in informing the public about the specific mission could campaigns awareness Furthermore, rationally. more needs patients’ satisfying thus visits, such for responses effective provide potentially could services care primary to accessibility Improved convenience. personal to according ED the to visits their deferring of capable be might patients sports major during these of some events. that be Acould explanation possible care emergency for come patients urgent less of number lower a that to theempirical staff ED of impressions toattest seem results These significant. triage subset where the difference in admission volume was ACKNOWLEDGEMENTS general the in account into taken be can findings primary and acute careservices. hospital both of organization and provision hours followingtheabove-mentionedevents. Some of these patients appear to conditions. defer their ED visits to the severe less with presenting those particularly ED, the in care seeking patients of number the in reduction 15. 14. 13. 12. 11. 10. FUNDING SOURCES CONFLICTS OFINTEREST insights. to Francisco Farrajota for valuable sharing his wise social-behavioral the thanks acknowledge special study.A this to for needed like data the would providing authors in Department, Statistics Centre Hospital Lisbon’s Central support provided by Sérgio Pedreiras and Pedro Piloto from

J. 2008;25:431-4. study.results ofasimulation in theNetherlands: population EmergMed patient department emergency general a in System TriageManchester van der Wulp I, van Baar ME, Schrijvers AJ. Reliability and validity of the project.org ISBN Austria Vienna, http://www.R-em: Disponível Dia]. Mês [consulted Ano 2012 3-900051-07-0. Computing. computing. Statistical statistical for emergency for Foundation the environment R and in language A triage Team. Core of overview An department. NursStand.2011;26:49-56. AS. Gloster L, Ganley related of 1999;44:75-6. analysis J. Med an Scott department. emergency 1998: and accident an Cup to attendances World Football The AP. Mattick Eur JPublicHealth.2013;23:383-5. England. in attendances assault department emergency on tournament football Cup World 2010 and the of Effects MA. Bellis loosing K, Hughes Z, Quigg Winning, JP. Shepherd violence. InjPrev. S, 2005;11:69-70. Moore V, Sivarajasingam These During None stated. None stated. The Rev EspSaludPublica.2003;77:735-47. Spain. Navarre, district, care Tafallahealth the in center extra-hospital an on games soccer televised of influence and demand emergency the Antonanzas M, Solaegui Diaz de Guerenu R, Guillen Grima F. Profile of ao sot eet, hr ses o e a be to seems there events, sports major . Acta MedPort2014Nov-Dec;27(6):700-703

ARTIGO ORIGINAL André ALMEIDA, Mónica EUSÉBIO, Jaime ALMEIDA, Matteo BOATTINI The Impact of the Lisbon Football Derby on the Profile of Emergency Department Admissions Acta Med Port 2014:27:700-703

Publicado pela Acta Médica Portuguesa, a Revista Científica da Ordem dos Médicos

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