急诊科肺栓塞检测时间的性别差异:生存分析

IF 3.6 4区 医学 Q2 PHARMACOLOGY & PHARMACY
Brandon C. Maughan MD, MHS, MSHP , Alexa Redmond MD, MPH , Yoona Shim BS , Nick Patrick MD , Mike J. Hildebrand , Bory Kea MD , Esther K. Choo MD, MPH , Angela F. Jarman MD, MPH
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引用次数: 0

摘要

研究目的:女性患者在心肌梗死、脑卒中等重大心血管疾病的诊断检测中存在延迟。本研究的目的是评估因肺栓塞(PE)被评估的急诊科(ED)患者进行初始诊断测试时间的性别差异。方法:样本包括2017年至2023年在3个ed中评估PE的15038名成年患者。主要结果是从ED到达到第一次诊断测试的时间。次要结果包括CT扫描完成时间和诊断为PE的患者入院时间。从电子病历中提取患者人口统计数据、病史、诊断测试单和ed操作因素。我们使用弹性网络回归策略进行变量选择,使用Cox比例风险模型进行生存分析。使用具有稳健标准误差的泊松回归来测量女性性别与第一次PE测试顺序时间的平均边际关联。结果:女性与首次PE检查的时间较慢相关(风险比(HR) 0.92[95%可信区间(CI) 0.88, 0.95]。结论:女性患者在急诊科进行PE诊断测试的时间较慢。未来的研究应该检查与性别有关的抗凝和其他治疗延迟。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Sex differences in time to testing for pulmonary embolism in the emergency department: a survival analysis

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.
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来源期刊
Clinical therapeutics
Clinical therapeutics 医学-药学
CiteScore
6.00
自引率
3.10%
发文量
154
审稿时长
9 weeks
期刊介绍: Clinical Therapeutics provides peer-reviewed, rapid publication of recent developments in drug and other therapies as well as in diagnostics, pharmacoeconomics, health policy, treatment outcomes, and innovations in drug and biologics research. In addition Clinical Therapeutics features updates on specific topics collated by expert Topic Editors. Clinical Therapeutics is read by a large international audience of scientists and clinicians in a variety of research, academic, and clinical practice settings. Articles are indexed by all major biomedical abstracting databases.
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