Research Priorities for the Influence of Gender on Diagnostic Imaging Choices in the Emergency Department Setting

Abstract

Diagnostic imaging is a cornerstone of patient evaluation in the acute care setting, but little effort has been devoted to understanding the appropriate influence of sex and gender on imaging choices. This article provides background on this issue and a description of the working group and consensus findings reached during the diagnostic imaging breakout session at the 2014 Academic Emergency Medicine consensus conference "Gender-specific Research in Emergency Care: Investigate, Understand, and Translate How Gender Affects Patient Outcomes." Our goal was to determine research priorities for how sex and gender may (or should) affect imaging choices in the acute care setting. Prior to the conference, the working group identified five areas for discussion regarding the research agenda in sex-and gender-based imaging using literature review and expert consensus. The nominal group technique was used to identify areas for discussion for common presenting complaints to the emergency department where ionizing radiation is often used for diagnosis: suspected pulmonary embolism, suspected kidney stone, lower abdominal pain with a concern for appendicitis, and chest pain concerning for coronary artery disease. The role of sex-and gender-based shared decision-making in diagnostic imaging decisions is also raised.

Appropriate use of medical imaging in two Spanish public hospitals: a cross-sectional analysis

“…Moreover, other studies have shown that gender affects the presentation of disease, the risk of testing and the diagnostic yield of a test. 29 Providers in general practice were less likely to order appropriate imaging test than those in central departments, something that Almén et al 5 already discussed. They argued that patients in general practice were prone to have more diffuse symptoms, which could lead to more inappropriate imaging tests compared with follow-up tests ordered by a specialist.…”

Gender-specific Research for Emergency Diagnosis and Management of Ischemic Heart Disease: Proceedings from the 2014Academic Emergency MedicineConsensus Conference Cardiovascular Research Workgroup

“…26 However, the risk-benefit ratio between using a test that requires ionizing radiation compared to one that does not require radiation remains unclear. 26 Ashurst et al 27 have discussed the sex-specific radiation risks with stress testing. The selection of tests may be limited due to differences, such as renal function, between men and women.…”

Sex‐related Differences in Emergency Department Renal Colic Management: Females Have Fewer Computed Tomography Scans but Similar Outcomes

“…13 We expected to see differences in all of these areas, with the largest differences in CT utilization, because of greater concerns about pelvic radiation in women.…”

“…Previous literature suggests that there are sex-based differences and presumed sex inequity in all of these areas. 7,[12][13][14][15][16][17] Published data suggest men are almost twice as likely to undergo CT imaging for renal colic, 7 but there is a paucity of ED research describing differential investigation, 13 management, disposition, intervention, and outcomes.…”