Sex differences in time to testing for pulmonary embolism in the emergency department: a survival analysis

Abstract

Study Objective

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).

Methods

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.

Results

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.

Conclusions

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.