Does sex influence the allocation of life support level by dispatchers in acute chest pain?

• Published in: The American journal of emergency medicine 2010, Vol.28 (8), p.922-927
• Main Authors: Gellerstedt, Martin, MSc, PhD, Bång, Angela, RN, PhD, Andréasson, Emma, MSc, Johansson, Anna, MSc, Herlitz, Johan, MD, PhD
• Format: Article
• Language: English
• Subjects: Acute chest pain; Acute Disease; Age Factors; Aged; Ambulances; Ambulances - statistics & numerical data; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Angina pectoris; Biological and medical sciences; Cardiology and Cardiovascular Disease; Chest Pain; Chest Pain - therapy; Chi-Square Distribution; Computer-Assisted; Decision Making; Decision Making, Computer-Assisted; Decision support systems; Dermatologi och venerologi, klinisk genetik, invärtesmedicin; Dermatology and venerology,clinical genetics, internal medicine; Electrocardiography; Emergency; Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care; Emergency medical care; Emergency Medical Services; Emergency Medical Services - statistics & numerical data; Female; Healthcare Disparities; Healthcare Disparities - statistics & numerical data; Heart attacks; Hospitals; Humans; Intensive care medicine; Internal medicine; Invärtesmedicin; Kardiologi och kardiovaskulära sjukdomar; Life Support Care; Life Support Care - statistics & numerical data; life support level; Logistic Models; Male; Medical sciences; MEDICIN; MEDICINE; Mortality; Myocardial infarction; Nursing science; Pain; Resource Allocation; sex; Sex Factors; Statistical models; statistics & numerical data; Studies; Sweden; therapy; Vårdvetenskap
• ISSN: 0735-6757; 1532-8171; 1532-8171
• DOI: 10.1016/j.ajem.2009.05.009

AbstractAimThe aim of this study was to evaluate ( a) the differences between men and women in symptom profile, allocated life support level (LSL), and presence of acute myocardial infarction (AMI), life-threatening condition (LTC), or death and ( b) whether a computer-based decision support system could improve the allocation of LSL. PatientsAll patients in Göteborg, Sweden, who called the dispatch center because of chest pain during 3 months (n = 503) were included in this study. MethodsAge, sex, and symptom profile were background variables. Based on these, we studied allocation of LSL by the dispatchers and its relationship to AMI, LTC, and death. All evaluations were made from a sex perspective. Finally, we studied the potential benefit of using a statistical model for allocating LSL. ResultsThe advanced life support level (ALSL) was used equally frequently for men and women. There was no difference in age or symptom profile between men and women in relation to allocation. However, the allocation of ALSL was predictive of AMI and LTC only in men. The sensitivity was far lower for women than for men. When a statistical model was used for allocation, the ALSL was predictive for both men and women. Using a separate model for men and women respectively, sensitivity increased, especially for women, and specificity was kept at the same level. ConclusionThis exploratory study indicates that women would benefit most from the allocation of LSL using a statistical model and computer-based decision support among patients who call for an ambulance because of acute chest pain. This needs further evaluation.