Exploring gender differences in pre-operative emergency room use in an inpatient pacemaker insertion population
Notice bibliographique
Résumé
Objective: The study is a prospective analysis of the Florida healthcare utilization project database. Records from the state inpatient database (SID) for the year 2010 and the state emergency department database (SEDD) for the years 2009 and 2010 have been used.Methods: There are 1,796 patients undergoing permanent pacemaker implants in the 2010 Florida inpatient discharge database according to our set inclusion criterion of all discharges with a primary procedure for initial pacemaker implant with diagnosis for bradycardia, heart block or both, in any position, in the SID. Three outcomes (emergency room [ER] history, true emergency and scheduled) were created based on the population’s ER experience within an observation period of 365 days. Descriptive statistics were used to describe patient demographics and clinical characteristics in the outcome groups. Binomial logistic regressions have been used to predict risk for inpatient pacemaker in females and our 3 outcome groups. The models have also been replicated using recursive partitioning methods.Results: Forty six percent of patients receiving a primary pacemaker in our data were women. Three hundred and five patients are scheduled, of which almost 41% are women; 697 patients are true emergencies, of which almost 45.5% are women and 769 patients have ER history, of which almost 48% are women. We found that sex does not affect outcomes. However, patient characteristics other than sex do affect outcomes, e.g., patients with Medicare as their primary payer are almost 65% less likely to have the ER history when compared with those having private insurance (OR: 0.35; 95% CI: 0.16-0.74) and likelihood for women to receive pacemakers increases by 64% in patients having 2 comorbidities on their discharge record when compared with those who have 3 or more comorbidities (OR: 1.64; 95% CI: 1.05-2.58).Conclusions: Consistent with previous literature, we did not find any significant differences among the sexes for primary pacemaker implants as well as ER use previous to implant. However subtle differences were observed in discrete patient characteristics like comorbidities, race and primary expected payer in sex-based and ER-utilization based groups. Cardiac events display high gender disparity and have high association with ER use. We have not found any previous study exploring these interactions. Future investigations in this subject should involve a larger sample size in order to carry out non-linear models of exploration along with stochastic analyses in order to increase validity of findings.
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Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,003 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».