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Paediatrics
Original research
Sex-specific differences in children attending the emergency department: prospective observational study
  1. Joany M Zachariasse1,
  2. Dorine M Borensztajn1,
  3. Daan Nieboer2,
  4. Claudio F Alves3,
  5. Susanne Greber-Platzer4,
  6. Claudia M G Keyzer-Dekker5,
  7. Ian K Maconochie6,
  8. Ewout W Steyerberg7,
  9. Frank J Smit8,
  10. Henriëtte A Moll1
  1. 1Department of General Paediatrics, Erasmus MC- Sophia Children’s Hospital, Rotterdam, The Netherlands
  2. 2Department of Public Health, Erasmus MC - University Medical Center, Rotterdam, The Netherlands
  3. 3Department of Paediatrics, Emergency Unit, Hospital Professor Doutor Fernando da Fonseca, Amadora, Portugal
  4. 4Department of Pediatrics and Adolescent Medicine, Medical University, Vienna, Austria
  5. 5Department of Pediatric Surgery, Erasmus MC- Sophia Children’s Hospital, Rotterdam, The Netherlands
  6. 6Department of Pediatric Emergency Medicine, Imperial College NHS Healthcare Trust, London, UK
  7. 7Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, The Netherlands
  8. 8Department of Paediatrics, Maasstad Hospital, Rotterdam, The Netherlands
  1. Correspondence to Dr Henriëtte A Moll; h.a.moll{at}erasmusmc.nl

Abstract

Objective To assess the role of sex in the presentation and management of children attending the emergency department (ED).

Design The TrIAGE project (TRiage Improvements Across General Emergency departments), a prospective observational study based on curated electronic health record data.

Setting Five diverse European hospitals in four countries (Austria, The Netherlands, Portugal, UK).

Participants All consecutive paediatric ED visits of children under the age of 16 during the study period (8–36 months between 2012 and 2015).

Main outcome measures The association between sex (male of female) and diagnostic tests and disease management in general paediatric ED visits and in subgroups presenting with trauma or musculoskeletal, gastrointestinal and respiratory problems and fever. Results from the different hospitals were pooled in a random effects meta-analysis.

Results 116 172 ED visits were included of which 63 042 (54%) by boys and 53 715 (46%) by girls. Boys accounted for the majority of ED visits in childhood, and girls in adolescence. After adjusting for age, triage urgency and clinical presentation, girls had more laboratory tests compared with boys (pooled OR 1.10, 95% CI 1.05 to 1.15). Additionally, girls had more laboratory tests in ED visits for respiratory problems (pooled OR 1.15, 95% CI 1.04 to 1.26) and more imaging in visits for trauma or musculoskeletal problems (pooled OR 1.10, 95% CI 1.01 to 1.20) and respiratory conditions (pooled OR 1.14, 95% CI 1.05 to 1.24). Girls with respiratory problems were less often treated with inhalation medication (pooled OR 0.76, 95% CI 0.70 to 0.83). There was no difference in hospital admission between the sexes (pooled OR 0.99, 95% CI 0.95 to 1.04).

Conclusion In childhood, boys represent the majority of ED visits and they receive more inhalation medication. Unexpectedly, girls receive more diagnostic tests compared with boys. Further research is needed to investigate whether this is due to pathophysiological differences and differences in disease course, whether girls present signs and symptoms differently, or whether sociocultural factors are responsible.

  • epidemiology
  • paediatric A&E and ambulatory care
  • paediatrics
https://creativecommons.org/licenses/by/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

https://doi.org/10.1136/bmjopen-2019-035918

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    Footnotes

    • Contributors JMZ contributed to the conceptualisation and design of the study, carried out the analyses, and drafted the initial manuscript. DMB, FJS, CFA, CMGK-D, IKM and SG-P contributed to the conceptualisation and design of the study, coordinated the data collection, contributed to interpretation of the data and critically reviewed the manuscript. DN and EWS contributed to the conceptualisation and design of the study, supervised the analyses and critically reviewed the manuscript. HAM contributed to the conceptualisation and design of the study, contributed to interpretation of the data, critically reviewed the manuscript and supervised the study. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval The study was approved by the medical ethical committees of the participating institutions: Medical Ethics Committee Erasmus MC (MEC-2013-567), Board of Directors Maasstad Ziekenhuis (L2013-103), Imperial College London Joint Research Compliance Office (14/WA/1051), Comissão de Ética para a Saúde do Hospital Prof. Dr. Fernando Fonseca EPE (Estudo Clínico TrIAGE – Parecer Favorável), Ethik Kommission Medizinische der Medizinischen Unversität Wien (EK Nr: 1405/2014). All waived the requirement for informed consent.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available upon reasonable request. Data from this study are available upon request to the corresponding author of the study (h.a.moll@erasmusmc.nl), subject to local rules and regulations.