Sex differences in febrile children with respiratory symptoms attending European emergency departments: An
Chantal D Tan1, Soufiane El Ouasghiri1, Ulrich von Both2,3
1Erasmus MC-Sophia Children's Hospital, Department of General Paediatrics, Rotterdam, The Netherlands.
Insights
Sex differences exist in how febrile children with respiratory symptoms present and are managed in European emergency departments. Girls received less inhalation medication but more antibiotics, warranting further investigation into causes.
Area of Science:
- Pediatric Emergency Medicine
- Clinical Pediatrics
- Health Services Research
Background:
- Febrile children with respiratory symptoms are common in emergency departments.
- Understanding sex-based differences in presentation and management is crucial for equitable care.
Purpose of the Study:
- To investigate sex disparities in the clinical presentation and management of febrile children with respiratory symptoms across European emergency departments.
- To identify potential factors contributing to observed sex differences in healthcare delivery.
Main Methods:
- An observational study involving 19,781 febrile children (0-18 years) with respiratory symptoms across 12 European emergency departments.
- Data collected on patient characteristics, diagnostic tests, treatments, and admission, stratified by sex.
- Multivariable logistic regression analyses were used to assess the association between sex and management, adjusting for covariates.
Main Results:
- Girls presented less frequently with tachypnea and increased work of breathing compared to boys.
- Girls received less inhalation medication (aOR 0.82) but more antibiotic treatment (aOR 1.09), potentially linked to higher UTI prevalence.
- Subgroup analyses revealed girls received less inhalation medication for lower respiratory tract infections and in children under five.
Conclusions:
- Significant sex differences are evident in the presentation and management of febrile children with respiratory symptoms in European emergency settings.
- Further research is needed to explore the roles of clinician attitudes, symptom presentation variations, and disease severity in these disparities.
Objective:
To assess sex differences in presentation and management of febrile children with respiratory symptoms attending European Emergency Departments.
Design And Setting:
An observational study in twelve Emergency Departments in eight European countries.
Patients:
Previously healthy children aged 0-<18 years with fever (≥ 38°C) at the Emergency Department or in the consecutive three days before Emergency Department visit and respiratory symptoms were included.
Main Outcome Measures:
The main outcomes were patient characteristics and management defined as diagnostic tests, treatment and admission. Descriptive statistics were used for patient characteristics and management stratified by sex. Multivariable logistic regression analyses were performed for the association between sex and management with adjustment for age, disease severity and Emergency Department. Additionally, subgroup analyses were performed in children with upper and lower respiratory tract infections and in children below five years.
Results:
We included 19,781 febrile children with respiratory symptoms. The majority were boys (54%), aged 1-5 years (58%) and triaged as low urgent (67%). Girls presented less frequently with tachypnea (15% vs 16%, p = 0.002) and increased work of breathing (8% vs 12%, p<0.001) compared with boys. Girls received less inhalation medication than boys (aOR 0.82, 95% CI 0.74-0.90), but received antibiotic treatment more frequently than boys (aOR 1.09, 95% CI 1.02-1.15), which is associated with a higher prevalence of urinary tract infections. Amongst children with a lower respiratory tract infection and children below five years girls received less inhalation medication than boys (aOR 0.77, 95% CI 0.66-0.89; aOR 0.80, 95% CI 0.72-0.90).
Conclusions:
Sex differences concerning presentation and management are present in previously healthy febrile children with respiratory symptoms presenting to the Emergency Department. Future research should focus on whether these differences are related to clinicians' attitudes, differences in clinical symptoms at the time of presentation and disease severity.
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