Age and gender disparities in administration of opioid for cardiac chest pain in the emergency department
Bibliographic record
Abstract
BACKGROUND: Previous data have shown sex differences in pain management for patients with cardiac chest pain in the emergency department (ED); however, the joint effect of sex and age on opioid administration has not been well studied. This study aimed to evaluate the combined effect of age and sex on the administration of opioid analgesics, specifically morphine and fentanyl, in ED patients presenting with cardiac chest pain. METHODS: This retrospective observational study included adults aged 18 years and older who presented to a single tertiary academic ED with acute cardiac chest pain between 2021 and 2025. Patients were categorized into four age-sex groups: older women (>57 years), younger women (18-57 years), older men (>57 years), and younger men (18-57 years). The primary outcome was the administration of intravenous (IV) morphine or fentanyl during the ED visit. Multivariable logistic regression was used to examine the association between these groups and the administration of opioids. FINDINGS: Among 1,870 eligible patients, 474 (25.4%) were older women, 323 (17.3%) were younger women, 659 (35.2%) were older men, and 414 (22.1%) were younger men. Compared to older women, all other age-sex groups had higher odds of receiving IVmorphine. Younger men had the highest odds (OR 2.19; 95% CI: 1.58-3.04; p < 0.001), followed by older men (OR 1.99; 95% CI: 1.22-3.26; p = 0.006) and younger women (OR 1.48; 95% CI: 0.87-2.52; p = 0.15), although the latter was not statistically significant. IV fentanyl use was low overall and did not differ significantly between groups. CONCLUSIONS: Older women were significantly less likely to receive IV morphine than men. These findings suggest the need for standardized pain protocols and targeted clinician education to reduce potential bias in ED pain management.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".