Sex Differences in Testing for Pulmonary Embolism Among Emergency Department Patients Aged 18-49 by Chief Complaint.

Background: Women undergo diagnostic testing for pulmonary embolism (PE) in greater numbers than men, despite the disease incidence being higher in men overall. It is unknown if testing for PE varies based on patient chief complaint.

Methods: This retrospective cohort study was conducted at two academic tertiary care hospitals. Nonpregnant adult patients (aged 18-49 years) were included if they presented to the ED between 1/1/2016 and 12/31/2018 with nontraumatic mechanisms and any of the following chief complaints: chest pain, shortness of breath, hemoptysis, or syncope AND had objective testing for PE. Data were obtained from the electronic medical record and analyzed descriptively. Four outcome variables were assessed: receipt of D-dimer testing, D-dimer positivity, receipt of pulmonary vascular imaging, and diagnosis of PE.

Results: We studied 1,991 unique patient encounters, most of whom (63%; 1,256/1,991) were female. Overall, female patients had higher odds of receiving D-dimer testing than male patients (OR 1.30, CI 1.06-1.59, P = 0.015), while they had lower odds of being diagnosed with PE (OR 0.57, CI 0.36-0.90, P = 0.019). However, this trend varied by chief complaint. Among patients with chest pain, females had higher odds of having a D-dimer performed (OR 1.35, CI 1.01-1.80, P = 0.049) and lower odds of being diagnosed with PE (OR 0.36, CI 0.18-0.70, P = 0.003) than males.

Conclusions: Both patient sex and chief complaint were associated with trends in diagnostic testing for PE. Among patients with chest pain, females are significantly more likely to be tested with a D-dimer and less likely to be diagnosed with PE.