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Original research
Sex disparities in the assessment and outcomes of chest pain presentations in emergency departments
  1. George Mnatzaganian1,
  2. Janet E Hiller2,3,
  3. George Braitberg4,
  4. Michael Kingsley1,
  5. Mark Putland5,
  6. Melanie Bish1,
  7. Kathleen Tori6,
  8. Rachel Huxley7,8
  1. 1 La Trobe Rural Health School, La Trobe University - Bendigo Campus, Bendigo, Victoria, Australia
  2. 2 Swinburne University of Technology, Hawthorn, Victoria, Australia
  3. 3 School of Public Health, University of Adelaide, Adelaide, South Australia, Australia
  4. 4 Centre for Integrated Critical Care Medicine, Department of Medicine and Radiology, University of Melbourne, Melbourne, Victoria, Australia
  5. 5 Emergency Medicine, Royal Melbourne Hospital, Melbourne, Victoria, Australia
  6. 6 School of Health Sciences, University of Tasmania, Launceston, Tasmania, Australia
  7. 7 La Trobe University College of Science, Health and Engineering, Melbourne, Victoria, Australia
  8. 8 The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
  1. Correspondence to Professor Rachel Huxley, La Trobe University College of Science Health and Engineering, Melbourne, VIC 3086, Australia; R.Huxley{at}


Objective To determine whether sex differences exist in the triage, management and outcomes associated with non-traumatic chest pain presentations in the emergency department (ED).

Methods All adults (≥18 years) with non-traumatic chest pain presentations to three EDs in Melbourne, Australia between 2009 and 2013 were retrospectively analysed. Data sources included routinely collected hospital databases. Triage scoring of the urgency of presentation, time to medical examination, cardiac troponin testing, admission to specialised care units, and in-ED and in-hospital mortality were each modelled using the generalised estimating equations approach.

Results Overall 54 138 patients (48.7% women) presented with chest pain, contributing to 76 216 presentations, of which 26 282 (34.5%) were cardiac. In multivariable analyses, compared with men, women were 18% less likely to be allocated an urgency of ‘immediate review’ or ‘within 10 min review’ (OR=0.82, 95% CI 0.79 to 0.85), 16% less likely to be examined within the first hour of arrival to the ED by an emergency physician (0.84, 0.81 to 0.87), 20% less likely to have a troponin test performed (0.80, 0.77 to 0.83), 36% less likely to be admitted to a specialised care unit (0.64, 0.61 to 0.68), and 35% (p=0.039) and 36% (p=0.002) more likely to die in the ED and in the hospital, respectively.

Conclusions In the ED, systemic sex bias, to the detriment of women, exists in the early management and treatment of non-traumatic chest pain. Future studies that identify the drivers explaining why women presenting with chest pain are disadvantaged in terms of care, relative to men, are warranted.

  • AMI
  • bias
  • chest pain
  • emergency department
  • in-hospital mortality
  • sex
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  • Contributors GM and RH contributed to the research conception and design, data analysis and interpretation, manuscript drafting, and critical revision of the manuscript. GM analysed the data and is the guarantor of the study. GB contributed to data acquisition, data interpretation, manuscript drafting and critical revision of the manuscript. JEH and MK contributed to data interpretation, manuscript drafting and critical revision of the manuscript. MP, MB and KT contributed to manuscript drafting and critical revision of the manuscript. All authors had full access to all of the statistical analyses, graphs and tables in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis.

  • 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 Human Research Ethics Committee of Monash Health (13297Q) approved the study. De-identified data were used and the need for informed consent was waived by the ethical committee.

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

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.

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