Association of sex with the clinical course and outcome of internal emergency department patients: a secondary data analysis

Abstract

Background and importance Differences between men and women visiting the emergency department (ED) with nonsurgical complaints have mostly been investigated in small, diagnosis-based subpopulations.Objective This study investigated sex-differences in an unselected cohort of nonsurgical ED patients.Design Secondary data of all patients attending two EDs of the Charité, Universitätsmedizin Berlin collected in the framework of their medical evaluation was reviewed. Settings and participantsWithin a 1-year-period all 34 333 adult internal patients presenting to one of the two EDs were included and analysed.Outcomes measure and analyses Sex-stratified descriptive analysis of the in-hospital course and outcome of the ED patients was performed as primary endpoint. Admission data, ED processes and diagnoses were analyzed as secondary endpoints.Main results A total of 51.2% of all patients were women. Women were slightly younger (median 56 years vs. men 58 years; P < 0.001) and presented more frequently with abdominal pain and headache. Men rather showed chest pain and dyspnea. Accordingly, women had more gastroenterological diseases; men were more often diagnosed with cardiological and pneumological diseases. Women were less frequently admitted for inpatient treatment [35.3 vs. men 43.7%; difference 8.4 percentage points (95% confidence interval (CI), 7.3-9.4)] and intensive care treatment [5.8 vs. men 9.0%; difference 3.2 percentage points (95% CI, 2.7-3.8)]. Inpatient-mortality did not show significant sex differences [4.6 women vs. 4.8% men; difference 0.2 percentage points (95% CI, −0.6 to 0.8)].Conclusions There are significant differences in characteristics, symptoms, diagnoses and clinical course between men and women. Further investigations could identify causes and measures like sex-specific algorithms for ED-work processes.

The association of biological sex and long-term outcomes in patients with acute dyspnea at the emergency department

“…A recent analysis of over 2000 publications in the field of emergency medicine showed that only 24% of studies reported biological sex as an independent variable [12]. Previous studies show that women and men show marked differences in disease prevalence, clinical presentation, response to treatment and outcomes [13,14]. Therefore, taking into account the differences related to biological sex is essential for the success of clinical care and favorable long-term outcomes in ED patients presenting with dyspnea.…”