Médecine d'urgence: libre accès
Libre accès

Abstrait

Evidence that Gender Effects on Time-to-ECG may be attributable to differences in Atypical Presentations

McGregor Alyson J, Madsen Tracy, Napoli Anthony, Weinstock Brett, Machan Jason T and Becker Bruce

Electrocardiogram (ECG) completion within 10 minutes for patients with suspected coronary heart disease is a quality marker for acute coronary syndrome (ACS). Controversy exists as to whether differences between genders in the frequency of atypical symptoms cause the observed differences in times to ECG (TECG) acquisition. Our goal was to assess whether delays observed between genders was attributable to differences in atypical symptom rates. Methods: Retrospective cross-sectional analysis of 8747 patients presenting to a Level 1 trauma hospital with a pre-specified set of “atypical” or “typical” chief complaints for ACS. Three-hundred patients were randomly selected for review. Hypotheses regarding TECG were tested using Kaplan-Meier survival analysis and proportional hazards regression. Chi-square, t-test, and Fisher’s exact test were used to compare demographic variables. Results: The sample consisted of 167 women and 133 men. Atypical complaints, walk-in, lower ESI Triage Criteria, and age <50yrs were each associated with longer TECG. The median TECG was 19 (95%CI 13-94) minutes for males and 83 (95%CI 20- UK) for females. Neither Kaplan Meier Survival analysis nor proportional hazards regression showed a significant difference between the TECG in men versus women or differences in gender within atypical and typical. Conclusions: There was no statistically significant difference between rates of atypical symptoms between men (43%) and women (57%). Presentation with atypical symptoms affected the likelihood, therefore, speed of TECG. These results suggest that, were there observed differences in atypical symptom rates between genders in other studies; these may have contributed in part or full to any observed differences between genders in TECG.