Pikwer Andreas, Carlsson Madeleine, Mahmoud Duraid Abod, Castegren Markus
Centre for Clinical Research Sörmland, Uppsala University, Uppsala, Sweden.
Department of Clinical Sciences at Malmö, Anaesthesiology and Intensive Care, Lund University, Lund, Sweden.
Emerg Med Int. 2020 Jul 21;2020:4823095. doi: 10.1155/2020/4823095. eCollection 2020.
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.
To study whether the gender of patients influenced physicians' tendency to suspect sepsis and propose correct initial sepsis treatment in constructed cases.
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.
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, < 0.01 and Case 2: 25/62 vs 13/58, < 0.05).
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.
男性是脓毒症发生的独立危险因素。除了免疫方面的性别差异外，女性一旦被诊断为脓毒症，接受治疗的频率较低。在其他疾病中也描述了性别差异，如急性冠状动脉综合征。
研究在虚构病例中患者性别是否会影响医生怀疑脓毒症的倾向以及提出正确的初始脓毒症治疗方案。
构建了4个病例以满足脓毒症-3标准，并引发对其他常见医学鉴别诊断的临床怀疑。其中2个病例有两个版本，仅患者性别不同。这两个版本随机分发给瑞典一个医疗区域的所有临床医生。要求做出回应的医生说出每个病例最重要的三个诊断和最重要的三种初始治疗方法。如果脓毒症与液体和抗生素一起出现在所述诊断中，则该病例被视为被正确识别并得到初始脓毒症治疗。
120名医院医生回答了这些病例。当患者为女性时，与患者为男性时相比，受访者正确识别并治疗脓毒症的频率显著更高（病例1：12/58对2/62，<0.01；病例2：25/62对13/58，<0.05）。
在4个虚构病例中，瑞典医生识别并提出脓毒症治疗方案的比例较低。当患者强烈模仿男性常见的其他诊断时，男性病例被正确识别并接受脓毒症治疗的频率较低。
