Abstract
ObjectiveTo assess the role of sex in the presentation and management of children attending the emergency department (ED).DesignThe TrIAGE project (TRiage Improvements Across General Emergency departments), a prospective observational study based on curated electronic health record data.SettingFive diverse European hospitals in four countries (Austria, The Netherlands, Portugal, UK).ParticipantsAll consecutive paediatric ED visits of children under the age of 16 during the study period (8–36 months between 2012 and 2015).Main outcome measuresThe 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.Results116 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).ConclusionIn 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.
Highlights
Of all 119 209 emergency department (ED) visits included in the TrIAGE cohort, 116 757 ED visits (98%) were included in the study
Relation between sex and age, triage urgency and clinical presentation In the total study population, the sex imbalance in number of ED visits changed with age
They had the highest proportion of ED visits with dermatological, respiratory and traumatic symptoms, while in children presenting with cardiac, ear, nose and throat, gastrointestinal and neurological conditions, the boy to girl ratio was almost equal
Summary
The epidemiology, pathophysiology, treatment and outcome of many diseases.[1,2,3] The Institute of Medicine has emphasised that sex is an important variable that should be considered in biomedical and health related research.[4] Sex refers to the biological differences between men and women, while gender refers to a broader concept including social and cultural distinctions associated with a given sex.[3] In the area of emergency medicine, sex and gender-specific differences have been found in adults, in topics as broad as the clinical presentation and outcomes of acute myocardial infarction,[5] the prevalence and survival of out-o f-hospital cardiac arrest[6] and the epidemiology of sports-related injuries.[7].
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