{"pk":42263,"title":"Impact of Daily Maximum Temperature on Emergency Department Arrivals and Acuity Levels","subtitle":null,"abstract":"<p><strong>Introduction:</strong> Heatwaves are becoming more frequent and severe globally. Heat is associated with increases in emergency department (ED) volumes and higher morbidity for a range of chronic conditions. We describe how temperature impacts ED arrivals at different acuity levels.</p>\n<p><strong>Methods:</strong> We obtained time-series records for daily ED arrivals stratified by Emergency Severity Index (ESI) from 2010 – 2019 from hospital records. Wet-bulb temperature was the exposure of interest; analysis was controlled for precipitation, snow, wind speed, day of week, and federal holidays. We fitted a Poisson model for each ESI category and estimated the association between temperature and ED arrival acuity with a distributed lag non-linear model with three days of lag to account for delayed health effects of temperature.</p>\n<p><strong>Results:</strong> We analyzed data for 3,652 days totaling 556,663 arrivals between 2010 – 2019. At lag 0, lower temperatures were associated with a reduced relative risk of arrival to the ED for ESI 2, ESI 3, and total arrivals. At higher temperatures, ESI 2 and ESI 3 showed an increased relative risk of arrival (wet-bulb exposure of 25°C at 0-day lag: ESI 2 RR = 1.06 [1.02–1.10]; ESI 3 RR = 1.04 [1.01-1.07]). While not statistically significant, ESI 1 exhibited a subtle increase in arrivals at the highest temperatures while ESI 4 &amp; 5 displayed a subtle decrease in relative risk of arrivals under these conditions.</p>\n<p><strong>Conclusion:</strong> Extremes of temperature, particularly heat, appear to affect ED arrivals differently across different acuity levels. Medium- to higher-acuity presentations appear to be more responsive to heat, with a statistically significant increase in ED presentations on days with the highest heat burden. The highest acuity presentations became numerically but not statistically more frequent on days with the highest heat burden, while the lowest acuity presentations decreased numerically but not statistically in these conditions.</p>","language":"eng","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"climate change"},{"word":"Heat exposure"},{"word":"climate adaptation"},{"word":"ED utilization"},{"word":"ED volumes"},{"word":"Acuity level"},{"word":"Emergency Severity Index"},{"word":"ESI"},{"word":"Distributed Lag Non-Linear Model (DLNM)"}],"section":"Climate Change","is_remote":true,"remote_url":"https://escholarship.org/uc/item/35h9r5h3","frozenauthors":[{"first_name":"Catharina","middle_name":"","last_name":"Giudice","name_suffix":"","institution":"Beth Israel Deaconess Medical Center, Department of Emergency Medicine, Boston,  Massachusetts; Harvard T.H. Chan School of Public Health, Harvard Chan Center for Climate,  Health and the Global Environment, Department of Environmental Health, Boston,  Massachusetts","department":""},{"first_name":"Nicholas","middle_name":"J.","last_name":"Arisco","name_suffix":"","institution":"Harvard T.H. Chan School of Public Health Department of Global Health and  Population, Boston, Massachusetts","department":""},{"first_name":"Zilin","middle_name":"","last_name":"Lu","name_suffix":"","institution":"Tufts University, Department of Public Health and Community Medicine, Boston,  Massachusetts","department":""},{"first_name":"Bryan","middle_name":"","last_name":"Stenson","name_suffix":"","institution":"Beth Israel Deaconess Medical Center, Department of Emergency Medicine, Boston,  Massachusetts","department":""},{"first_name":"Caleb","middle_name":"","last_name":"Dresser","name_suffix":"","institution":"Beth Israel Deaconess Medical Center, Department of Emergency Medicine, Boston,  Massachusetts; Harvard T.H. Chan School of Public Health, Harvard Chan Center for Climate,  Health and the Global Environment, Department of Environmental Health, Boston,  Massachusetts","department":""}],"date_submitted":"2025-02-07T04:19:47.881000+06:00","date_accepted":"2025-05-07T18:20:02.810000+06:00","date_published":"2025-09-26T09:52:00+06:00","render_galley":null,"galleys":[{"label":"PDF","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/42263/galley/40010/download/"}]}