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Published on: April 29, 2013
Sex-specific differences in children attending the emergency department: prospective observational study
Joany M Zachariasse1, Dorine M Borensztajn1, Daan Nieboer2
1Department of General Paediatrics, Erasmus MC- Sophia Children's Hospital, Rotterdam, The Netherlands.
Insights
Boys visit the emergency department (ED) more in childhood, receiving more inhalation medication. Girls, however, undergo more diagnostic tests overall, particularly for respiratory issues and trauma, warranting further investigation into underlying causes.
Area of Science:
- Pediatric Emergency Medicine
- Clinical Epidemiology
- Health Services Research
Background:
- Sex differences in healthcare utilization and management are increasingly recognized.
- Understanding these disparities in pediatric emergency departments (EDs) is crucial for equitable care.
- The TrIAGE project aimed to investigate sex-based variations in pediatric ED encounters.
Purpose of the Study:
- To evaluate the influence of sex on the presentation and management of pediatric patients in emergency departments.
- To identify potential sex-based differences in diagnostic testing and treatment strategies.
- To explore these differences across various pediatric conditions, including trauma, respiratory, and gastrointestinal issues.
Main Methods:
- A prospective observational study utilizing curated electronic health record data from the TrIAGE project.
- Inclusion of over 116,000 consecutive pediatric ED visits across five diverse European hospitals.
- Random effects meta-analysis was employed to pool results and assess associations between sex and clinical management.
Main Results:
- Boys constituted the majority of ED visits in childhood, while girls predominated in adolescence.
- Girls received significantly more laboratory tests overall and for respiratory conditions compared to boys.
- Girls with trauma/musculoskeletal or respiratory conditions underwent more imaging, but received less inhalation medication for respiratory issues.
- No significant sex difference was observed in hospital admission rates.
Conclusions:
- While boys are seen more in childhood EDs and receive more inhalation medication, girls undergo more diagnostic tests.
- The observed sex-based differences in diagnostic testing and treatment require further investigation.
- Potential contributing factors include pathophysiological variations, differences in disease presentation, or sociocultural influences.
Objective:
To assess the role of sex in the presentation and management of children attending the emergency department (ED).
Design:
The TrIAGE project (TRiage Improvements Across General Emergency departments), a prospective observational study based on curated electronic health record data.
Setting:
Five diverse European hospitals in four countries (Austria, The Netherlands, Portugal, UK).
Participants:
All consecutive paediatric ED visits of children under the age of 16 during the study period (8-36 months between 2012 and 2015).
Main Outcome Measures:
The association between sex (male of female) and diagnostic tests and disease management in general paediatric ED visits and in subgroups presenting with trauma or musculoskeletal, gastrointestinal and respiratory problems and fever. Results from the different hospitals were pooled in a random effects meta-analysis.
Results:
116 172 ED visits were included of which 63 042 (54%) by boys and 53 715 (46%) by girls. Boys accounted for the majority of ED visits in childhood, and girls in adolescence. After adjusting for age, triage urgency and clinical presentation, girls had more laboratory tests compared with boys (pooled OR 1.10, 95% CI 1.05 to 1.15). Additionally, girls had more laboratory tests in ED visits for respiratory problems (pooled OR 1.15, 95% CI 1.04 to 1.26) and more imaging in visits for trauma or musculoskeletal problems (pooled OR 1.10, 95% CI 1.01 to 1.20) and respiratory conditions (pooled OR 1.14, 95% CI 1.05 to 1.24). Girls with respiratory problems were less often treated with inhalation medication (pooled OR 0.76, 95% CI 0.70 to 0.83). There was no difference in hospital admission between the sexes (pooled OR 0.99, 95% CI 0.95 to 1.04).
Conclusion:
In childhood, boys represent the majority of ED visits and they receive more inhalation medication. Unexpectedly, girls receive more diagnostic tests compared with boys. Further research is needed to investigate whether this is due to pathophysiological differences and differences in disease course, whether girls present signs and symptoms differently, or whether sociocultural factors are responsible.
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