La Trobe Rural Health School, La Trobe University - Bendigo Campus, Bendigo, Victoria, Australia.
Swinburne University of Technology, Hawthorn, Victoria, Australia.
Heart. 2020 Jan;106(2):111-118. doi: 10.1136/heartjnl-2019-315667. Epub 2019 Sep 25.
To determine whether sex differences exist in the triage, management and outcomes associated with non-traumatic chest pain presentations in the emergency department (ED).
All adults (≥18 years) with non-traumatic chest pain presentations to three EDs in Melbourne, Australia between 2009 and 2013 were retrospectively analysed. Data sources included routinely collected hospital databases. Triage scoring of the urgency of presentation, time to medical examination, cardiac troponin testing, admission to specialised care units, and in-ED and in-hospital mortality were each modelled using the generalised estimating equations approach.
Overall 54 138 patients (48.7% women) presented with chest pain, contributing to 76 216 presentations, of which 26 282 (34.5%) were cardiac. In multivariable analyses, compared with men, women were 18% less likely to be allocated an urgency of 'immediate review' or 'within 10 min review' (OR=0.82, 95% CI 0.79 to 0.85), 16% less likely to be examined within the first hour of arrival to the ED by an emergency physician (0.84, 0.81 to 0.87), 20% less likely to have a troponin test performed (0.80, 0.77 to 0.83), 36% less likely to be admitted to a specialised care unit (0.64, 0.61 to 0.68), and 35% (p=0.039) and 36% (p=0.002) more likely to die in the ED and in the hospital, respectively.
In the ED, systemic sex bias, to the detriment of women, exists in the early management and treatment of non-traumatic chest pain. Future studies that identify the drivers explaining why women presenting with chest pain are disadvantaged in terms of care, relative to men, are warranted.
确定在急诊科（ED）中，非创伤性胸痛表现的分诊、管理和结局是否存在性别差异。
回顾性分析了 2009 年至 2013 年期间澳大利亚墨尔本的三家 ED 中所有≥18 岁的非创伤性胸痛表现的成年人。数据来源包括常规收集的医院数据库。使用广义估计方程方法对分诊评分、就诊时间、肌钙蛋白检测、收入专科治疗单元以及 ED 内和住院内死亡率进行建模。
共有 54138 名患者（48.7%为女性）因胸痛就诊，共就诊 76216 次，其中 26282 次（34.5%）为心脏原因。在多变量分析中，与男性相比，女性被分配为“立即复查”或“10 分钟内复查”的可能性低 18%（OR=0.82，95%CI 0.79 至 0.85），由急诊医师在到达 ED 后 1 小时内进行检查的可能性低 16%（0.84，0.81 至 0.87），进行肌钙蛋白检测的可能性低 20%（0.80，0.77 至 0.83），收入专科治疗单元的可能性低 36%（0.64，0.61 至 0.68），ED 内和住院内死亡率分别高 35%（p=0.039）和 36%（p=0.002）。
在 ED，非创伤性胸痛的早期管理和治疗中存在系统性性别偏见，这对女性不利。需要进一步研究确定为什么与男性相比，女性在护理方面处于不利地位的原因。
