engleski

Chest radiography in Emergency Room: Do we treat men and women same?

Background: Chest radiography (CR) is the most prescribed radiologic test performed on patients (pts) treated within Emergency Department (ED). It is cheap, quickly obtainable and available. Data on gender differences related to prescribing CR in ED are sparse. Aim: to investigate gender differences on prescribing CR, CR findings and predictors of pathologic CR findings in patients presented to ED. Methods: the authors analysed electronic data on ED visits („all-comers“) of a single University Hospital Center for a period of 18 days (Decembre 20th 2012 to January 06 2013), retrospectively. Data on medical history, chief complaint, main diagnosis, demographics and recommendations were collected. Statistical analysis was performed by using SPSS. Results: a total of 949 patients visited ED during named period, with slight female predominance (47, 0%). Female pts were generally older (59, 8 vs 59, 5 years ; not significant (ns)), spent less time in ED, more often had history of hypertension 846, 8% vs 45, 0%), most common chief complaint was abdominal pain (20, 1%) followed by chest pain (16, 9%). Male pts had higher frequency of diabetes (14, 3% vs 12, 0%), chronic obstructive pulmonary disease (9, 7% vs 6, 8%), coronary artery disease (CAD) (13, 2% vs 7, 0%) reported in medical history, most common chief complaint was chest pain (19, 6%) followed by dyspnea (13, 9%). CR was more often performed in male pts (41, 0% vs. 38, 6%), but the finding was more often normal in female (55, 1% vs. 50, 8%), both of these differences failed to reach statistical significance. Cardiomegaly, pleural effusion and pulmonary congestion were the most common radiologic findings for both genders. When pts with chest pain as chief complaint were stratified for gender, analysis showed that female pts more often underwent chest radiography (57, 6% vs 49, 4%, ns). Statistical significance was reached in group of patients younger than 45 years, where pathologic finding was more often found in male pts (p=0, 026). However, due to low number of pts, this finding should be interpreted with caution. On logistic regression, pathologic findings were predicted with dyspnea as the chief complaint (p>0, 00001) and history of heart failure (p>0, 0000001). For female pts elevated body temperature as chief complaint (p=0, 015) and history of CAD (p=0, 015) also predicted pathologic finding. For male pts the same was observed for chest pain as chief complaint (p=0, 048), while predictors found in female pts did not reach statistical significance. Conclusion: the authors failed to prove major significant gender difference in radiologic workup in emergency setting. Nevertheless, some trends were observed and although the total number of pts included in the study was substantial (n=949), upon gender and radiology workup stratification the number of pts in subgroups remained relatively low. Of topic, the authors want to stress out the vast number of normal findings obtained in our study (53, 1%). This urges for clear guidelines and recommendations for chest radiography in ED, since radiation exposure and costs are substantial, given the large number of examinations.

Chest radiography; gender differences; emergency department

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