Maughan Brandon C, Redmond Alexa, Shim Yoona, Patrick Nick, Hildebrand Mike J, Kea Bory, Choo Esther K, Jarman Angela F
Department of Emergency Medicine, Oregon Health & Science University, Portland Oregon.
Department of Emergency Medicine, Oregon Health & Science University, Portland Oregon.
Clin Ther. 2025 Jun 4. doi: 10.1016/j.clinthera.2025.04.014.
Female patients experience delays in diagnostic testing for major cardiovascular diseases such as myocardial infarction and stroke. The objective of this study was to assess sex differences in the time to initial diagnostic testing among emergency department (ED) patients evaluated for pulmonary embolism (PE).
The sample included 15,038 adult patients evaluated for PE in 3 EDs from 2017 to 2023. The primary outcome was the time from ED arrival to the first order of a diagnostic test. Secondary outcomes included time to CT scan completion and time to admission for patients diagnosed with PE. Data on patient demographics, medical history, diagnostic test orders, and ED-operational factors were extracted from the electronic medical record. We performed survival analysis with a Cox proportional hazards model using an elastic net regression strategy for variable selection. Poisson regression with robust standard errors was used to measure the average marginal association of female sex with time to first PE test order.
Female sex was associated with a slower time to first PE test (hazard ratio (HR) 0.92 [95% confidence interval (CI) 0.88, 0.95], p<0.001) with an average delay of 7.2 minutes [95% CI 4.6, 9.8] compared to male patients. Secondary outcomes noted similar delays to CT scan completion (HR 0.85 [95% CI 0.8, 0.89], average 14.1 minutes [95% CI 9.3, 18.8]) and hospital admission (HR 0.83 [95% CI 0.71, 0.98], average 18.7 minutes [95% CI 1, 36.4]) for female patients compared to males.
Female patients experience slower times to diagnostic testing for PE in the emergency department. Future research should examine sex-associated delays to anticoagulation and other treatments.
女性患者在心肌梗死和中风等主要心血管疾病的诊断测试方面存在延迟。本研究的目的是评估因肺栓塞（PE）接受评估的急诊科（ED）患者在首次诊断测试时间上的性别差异。
样本包括2017年至2023年在3个急诊科接受PE评估的15038名成年患者。主要结局是从到达急诊科到首次开具诊断测试医嘱的时间。次要结局包括CT扫描完成时间和确诊为PE的患者入院时间。从电子病历中提取患者人口统计学、病史、诊断测试医嘱和急诊科运营因素的数据。我们使用弹性网回归策略进行变量选择，采用Cox比例风险模型进行生存分析。使用具有稳健标准误的泊松回归来衡量女性性别与首次PE测试医嘱时间的平均边际关联。
女性性别与首次PE测试时间较慢相关（风险比（HR）0.92 [95%置信区间（CI）0.88, 0.95]，p<0.001），与男性患者相比平均延迟7.2分钟[95% CI 4.6, 9.8]。次要结局显示，女性患者在CT扫描完成时间（HR 0.85 [95% CI 0.8, 0.89]，平均14.1分钟[95% CI 9.3, 18.8]）和入院时间（HR 0.83 [95% CI 0.71, 0.98]，平均18.7分钟[95% CI 1, 36.4]）方面与男性患者相比也有类似延迟。
女性患者在急诊科进行PE诊断测试的时间较慢。未来的研究应检查与性别相关的抗凝及其他治疗延迟情况。
