Abstract
Background Male sex is an independent risk factor for sepsis development. In addition to immunological gender differences, women less often receive sepsis treatment once diagnosed. Gender differences have also been described in other medical conditions, such as acute coronary syndrome. Aim To study whether the gender of patients influenced physicians' tendency to suspect sepsis and propose correct initial sepsis treatment in constructed cases. Method Four cases were constructed to fulfil the sepsis-3 criteria as well as raise clinical suspicions of other common medical differential diagnoses. Two of the cases were drafted in two versions, only differing in the gender of the patient. The two versions were randomly distributed to all clinical physicians in a medical region in Sweden. The responding physicians were asked to state the three most important diagnoses and the three most important initial treatments for each case. If sepsis were among the stated diagnoses together with fluids and antibiotics, the case was considered as correctly identified and initially treated sepsis. Results 120 hospital physicians answered the cases. In the case the patient was a female, the respondents correctly identified and treated sepsis significantly more often than if the patient was of the male sex (Case 1: 12/58 vs 2/62, p < 0.01 and Case 2: 25/62 vs 13/58, p < 0.05). Conclusion A low proportion of Swedish physicians identified and proposed treatment for sepsis in four constructed cases. In the case the patient strongly mimicked other diagnoses common in the male sex, the male cases were less often correctly identified and treated for sepsis.
Highlights
Sepsis is one of the leading causes of death in the intensive care unit (ICU), with mortality in severe sepsis and septic shock approximating 20% [1,2,3]
To further discern the reasons for gender disparities, we aimed to investigate whether the sex of the patient affects the clinicians’ decision-making when prioritizing between differential diagnoses
120 participants answered a questionnaire and returned them anonymously by regular mail, rendering a response frequency of 45.7%. e participants were evenly distributed among the age groups, position, and medical specialties, Table 1
Summary
Sepsis is one of the leading causes of death in the intensive care unit (ICU), with mortality in severe sepsis and septic shock approximating 20% [1,2,3]. Several studies have identified male sex as an independent risk factor for the development of severe infection and sepsis [7,8,9]. If sepsis were among the stated diagnoses together with fluids and antibiotics, the case was considered as correctly identified and initially treated sepsis. In the case the patient was a female, the respondents correctly identified and treated sepsis significantly more often than if the patient was of the male sex (Case 1: 12/58 vs 2/62, p < 0.01 and Case 2: 25/62 vs 13/58, p < 0.05). In the case the patient strongly mimicked other diagnoses common in the male sex, the male cases were less often correctly identified and treated for sepsis
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