Sex-based differences in ED management of critically ill patients with sepsis: a nationwide cohort study
Open Access
- 1 April 2020
- journal article
- research article
- Published by Springer Science and Business Media LLC in Intensive Care Medicine
- Vol. 46 (4), 727-736
- https://doi.org/10.1007/s00134-019-05910-9
Abstract
Purpose To compare management and outcomes for critically ill women and men with sepsis in the emergency medical services (EMS), the emergency department (ED) and the ICU. Methods We used two prospectively compiled Swedish national quality registers, the National Quality Sepsis Registry and the Swedish Intensive Care Registry to identify a nationwide cohort of 2720 adults admitted to an ICU within 24 h of arrival to any of 32 EDs, with a diagnosis of severe sepsis or septic shock between 2008 and 2015. Results Patients were 44.5% female. In the EMS, a higher fraction of men had all vital signs recorded-54.4 vs 49.9% (p = 0.02) and received IV fluids and oxygen-40.0 vs 34.8% (p = 0.02). In the ED, men had completed 1-h sepsis bundles in 41.5% of cases compared to 30.0% in women (p < 0.001), and shorter time to antibiotics-65 (IQR 30-136) vs 87 min (IQR 39-172) (p = 0.0001). There was no significant difference between men and women regarding ICU nursing workload, mechanical ventilation or ICU length of stay. In severity-adjusted multivariable analysis, OR for women achieving a completed sepsis bundle, compared to men was 0.64 (CI 0.51-0.81). Thirty-day mortality was 25.0% for women and 23.1% for men (p = 0.24). Adjusted OR for female death was 1.28 (CI 1.00-1.64), but the increased mortality was not mediated by differential bundle completion. Conclusions Women and men with severe sepsis or septic shock received differential care in the ED, but this did not explain higher odds of death in women.Funding Information
- Swedish Government Research Grant
- Center for Innovative Medicine, Karolinska Institute, Sweden
This publication has 34 references indexed in Scilit:
- Gender differences in outcome and use of resources do exist in Swedish intensive care, but to no advantage for women of premenopausal ageCritical Care, 2015
- Gender inequalities in the promptness of diagnosis of bladder and renal cancer after symptomatic presentation: evidence from secondary analysis of an English primary care audit surveyBMJ Open, 2013
- Gender-associated differences in access to trauma center care: A population-based analysisSurgery, 2012
- Gender differences in mortality in patients with severe sepsis or septic shockGender Medicine, 2010
- Sex Differences in the Use of Intravenous rt-PA Thrombolysis Treatment for Acute Ischemic StrokeStroke, 2009
- The effect of patients' sex on physicians' recommendations for total knee arthroplastyCMAJ : Canadian Medical Association Journal, 2008
- Sex-and age-based differences in the delivery and outcomes of critical careCMAJ : Canadian Medical Association Journal, 2007
- Gender-related differences in intensive care: A multiple-center cohort study of therapeutic interventions and outcome in critically ill patients*Critical Care Medicine, 2003
- Sex Differences in Cardiac CatheterizationJAMA, 2001
- Differences in the Use of Procedures between Women and Men Hospitalized for Coronary Heart DiseaseThe New England Journal of Medicine, 1991