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

Ayar, Prabakar Vaittinada; Motiejūnaitė, Justina; Čerlinskaitė, Kamilė; Deniau, Benjamin; Blet, Alice; Kavoliūnienė, Aušra; Mebazaa, Alexandre; Čelutkienė, Jelena; Azibani, Fériel

doi:10.1097/mej.0000000000000899

Cited by 5 publications

(4 citation statements)

References 31 publications

(39 reference statements)

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“…Biological sex was always described as a cofounder factor for long term outcome in many diseases. [3,24,25] Use of PR is more associated in men [26,27] in ED, as the present study where the proportion of PR were slightly higher in men. In practice, PR seemed useful for men rst to try to contain them in contrast for women it was to continue their treatment.…”

Section: Discussionsupporting

confidence: 60%

The association of biological sex and long-term outcomes in older patients with physical restraint at the emergency department

Manfredini,

Pépin,

Ayar

et al. 2024

Preprint

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Backgrounds: The worldwide population is ageing. Biological sex is first and foremost a genetic modifier of disease. To prevent self-arm many techniques can be used in older patients. Among them coercive measure consisting of physical restraint (PR) is one of the techniques. This study aims to assess the effects of the biological sex on the long-term survival after PR in geriatric patients during the initial emergency department (ED) visit. Methods: This retrospective study included patients between November 2019 to March 2021. All consecutive hospitalized patients after emergency department visit older than 75 years with PR were included. The population was compared according to the biological sex. One-year all-cause mortality was plotted with the Kaplan-Meier curve. Hazard ratios (HRs) for 1-year mortality were calculated using a Cox proportional hazards regression model. Mortality was monitored over a 3-year period. Results: PR was used in 149 patients representing 4.6% of 3210 hospitalized patients older than 75 years after ED visit. Women represented 52% of the study population. Compared to men, women were older [median (IQR) age 89 (85–93) vs. 85 (81–90) years, P = 0.002]. Women more often presented dementia (93 vs. 80%, P = 0.031). Both sexes presented the same limited autonomy. All-cause mortality was significantly lower for women than men after one year (25 vs. 51%, respectively, P = < 0.001). Likewise, adjusted HR of 1-year all-cause mortality was higher in men [a HR 3.1 (95% confidence interval 1.5–6.3), P < 0.001]. Conclusions: This study suggested that the use of physical restraint in older adults was a more related factor of mortality in men than women. In men PR use seemed to be a sign of global health decline. Further prospective studies are needed to assess if PR are a cause or a consequence of a global health decline.

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Section: Discussionsupporting

confidence: 60%

The association of biological sex and long-term outcomes in older patients with physical restraint at the emergency department

Manfredini,

Pépin,

Ayar

et al. 2024

Preprint

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“…We could suppose a representative bias in the respondents based on their clinical experience [13]. In some cases, for example, the prognosis for men and women is different [14]. However, this field of cognition has not yet been well investigated, especially in the context of ED, where the judgment must be clear and efficient [15].…”

Section: Discussionmentioning

confidence: 99%

Do emergency medicine health care workers rate triage level of chest pain differently based upon appearance in simulated patients?

Coisy,

Olivier,

Ageron

et al. 2023

European Journal of Emergency Medicine

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Background and importance There seems to be evidence of gender and ethnic bias in the early management of acute coronary syndrome. However, whether these differences are related to less severe severity assessment or to less intensive management despite the same severity assessment has not yet been established. Objective To show whether viewing an image with characters of different gender appearance or ethnic background changes the prioritization decision in the emergency triage area. Methods The responders were offered a standardized clinical case in an emergency triage area. The associated image was randomized among eight standardized images of people presenting with chest pain and differing in gender and ethnic appearance (White, Black, North African and southeast Asian appearance). Outcome measures and analysis Each person was asked to respond to a single clinical case, in which the priority level [from 1 (requiring immediate treatment) to 5 (able to wait up to 2 h)] was assessed visually. Priority classes 1 and 2 for vital emergencies and classes 3–5 for nonvital emergencies were grouped together for analysis. Results Among the 1563 respondents [mean age, 36 ± 10 years; 867 (55%) women], 777 (50%) were emergency physicians, 180 (11%) emergency medicine residents and 606 (39%) nurses. The priority levels for all responses were 1–5 : 180 (11%), 686 (44%), 539 (34%), 131 (9%) and 27 (2%). There was a higher reported priority in male compared to female [62% vs. 49%, difference 13% (95% confidence interval; CI 8–18%)]. Compared to White people, there was a lower reported priority for Black simulated patients [47% vs. 58%, difference −11% (95% CI −18% to −4%)] but not people of southeast Asian [55% vs. 58%, difference −3% (95% CI −10–5%)] and North African [61% vs. 58%, difference 3% (95% CI −4–10%)] appearance. Conclusion In this study, the visualization of simulated patients with different characteristics modified the prioritization decision. Compared to White patients, Black patients were less likely to receive emergency treatment. The same was true for women compared with men.

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“…En otros estudios hechos a nivel hospitalario, las mujeres tienen una mayor supervivencia a un año que los hombres tras la presentación inicial en urgencias por disnea aguda (Vaittinada Ayar et al, 2022)clinical presentation, response to treatment and outcomes. However, such data are scarce in the acutely ill. An awareness of differences related to biological sex is essential for the success of clinical care and outcomes in patients presenting with acute dyspnea, the most frequent cause of emergency department (ED.…”

Section: Discussionmentioning

confidence: 99%

Características de género asociadas a la insuficiencia respiratoria aguda en emergencias extra-hospitalarias. Un estudio observacional

Cintora-Sanz

Gutiérrez-Misis

2022

revTECHNO

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Antecedentes: Se desconoce la casuística descriptiva de la insuficiencia respiratoria aguda en emergencias extra-hospitalarias.Objetivos: Valorar el género de la insuficiencia respiratoria aguda, tanto aislada como relacionada con la insuficiencia respiratoria crónica, así como el edema agudo de pulmón (EAP).Resultados principales: De los 40130 pacientes, el 54,45% fueron mujeres frente al 45,54% de hombres En el EAP. En la insuficiencia respiratoria aguda no relacionada con insuficiencia respiratoria crónica, el porcentaje de mujeres fue del 56,53% y el de hombres del 43,47%. En la insuficiencia respiratoria aguda relacionada con insuficiencia respiratoria crónica el sexo masculino fue del 55,6% y el femenino 44,4%.

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

Cited by 5 publications

References 31 publications

The association of biological sex and long-term outcomes in older patients with physical restraint at the emergency department

The association of biological sex and long-term outcomes in older patients with physical restraint at the emergency department

Do emergency medicine health care workers rate triage level of chest pain differently based upon appearance in simulated patients?

Características de género asociadas a la insuficiencia respiratoria aguda en emergencias extra-hospitalarias. Un estudio observacional

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