Department of Anesthesiology, Intensive Care, Emergency and Pain Medicine, CHU de Nimes, University of Montpellier, Nimes, France.
Department of Emergency Medicine, Montpellier University Hospital, Montpellier, France.
Eur J Emerg Med. 2024 Jun 1;31(3):188-194. doi: 10.1097/MEJ.0000000000001113. Epub 2023 Dec 13.
There seems to be evidence of gender and ethnic bias in the early management of acute coronary syndrome. However, whether these differences are related to less severe severity assessment or to less intensive management despite the same severity assessment has not yet been established.
To show whether viewing an image with characters of different gender appearance or ethnic background changes the prioritization decision in the emergency triage area.
The responders were offered a standardized clinical case in an emergency triage area. The associated image was randomized among eight standardized images of people presenting with chest pain and differing in gender and ethnic appearance (White, Black, North African and southeast Asian appearance).
Each person was asked to respond to a single clinical case, in which the priority level [from 1 (requiring immediate treatment) to 5 (able to wait up to 2 h)] was assessed visually. Priority classes 1 and 2 for vital emergencies and classes 3-5 for nonvital emergencies were grouped together for analysis.
Among the 1563 respondents [mean age, 36 ± 10 years; 867 (55%) women], 777 (50%) were emergency physicians, 180 (11%) emergency medicine residents and 606 (39%) nurses. The priority levels for all responses were 1-5 : 180 (11%), 686 (44%), 539 (34%), 131 (9%) and 27 (2%). There was a higher reported priority in male compared to female [62% vs. 49%, difference 13% (95% confidence interval; CI 8-18%)]. Compared to White people, there was a lower reported priority for Black simulated patients [47% vs. 58%, difference -11% (95% CI -18% to -4%)] but not people of southeast Asian [55% vs. 58%, difference -3% (95% CI -10-5%)] and North African [61% vs. 58%, difference 3% (95% CI -4-10%)] appearance.
In this study, the visualization of simulated patients with different characteristics modified the prioritization decision. Compared to White patients, Black patients were less likely to receive emergency treatment. The same was true for women compared with men.
急性冠状动脉综合征的早期管理中似乎存在性别和种族偏见的证据。然而，这些差异是与严重程度评估较轻有关，还是与严重程度评估相同但管理不那么密集有关，尚未确定。
展示查看具有不同性别和种族背景特征的图像是否会改变急诊分诊区的优先排序决策。
在急诊分诊区为响应者提供了一个标准化的临床病例。与呈现胸痛的八个人的标准化图像相关联的图像随机化，这些图像在性别和种族外观上有所不同（白人、黑人、北非和东南亚外观）。
在 1563 名应答者中（平均年龄 36±10 岁；867 名女性，占 55%），777 名（50%）是急诊医师，180 名（11%）是急诊医学住院医师，606 名（39%）是护士。所有应答的优先级均为 1-5：180（11%）、686（44%）、539（34%）、131（9%）和 27（2%）。男性报告的优先级高于女性[62%比 49%，差异 13%（95%置信区间；CI 8-18%）]。与白人相比，黑人模拟患者的报告优先级较低[47%比 58%，差异-11%（95%CI-18%至-4%）]，但东南亚[55%比 58%，差异-3%（95%CI-10-5%）]和北非[61%比 58%，差异 3%（95%CI-4-10%）]的模拟患者并非如此。
在这项研究中，具有不同特征的模拟患者的可视化改变了优先级决策。与白人患者相比，黑人患者不太可能接受紧急治疗。女性与男性相比也是如此。
