Gender bias in the evaluation and management of acute nontraumatic chest pain. The St. Louis Emergency Physicians' Association Research Group.

BACKGROUND: Prior studies suggest a gender-based difference in the management of myocardial ischemia in nonacute settings. We examined whether there was a gender difference in the emergency department evaluation and management of patients with acute chest pain. METHODS: A record review from 10 St. Louis metropolitan emergency departments was done on all patients over 35 years old who presented with acute nonpleuritic, nontraumatic chest pain. We reviewed for the presence of cardiac risk factors, prior cardiac disease, time to physician evaluation, and time to initial electrocardiogram. In the patient subgroup admitted from the emergency department with a diagnosis of myocardial infarction or unstable angina, disposition was noted. RESULTS: Women waited longer than men for an initial physician evaluation and an initial electrocardiogram. In the patient subgroup with acute myocardial ischemia, a smaller percentage of women than men (56.0% vs 82.8%) were admitted to an intensive care unit. CONCLUSION: In patients with acute nonpleuritic, nontraumatic chest pain, women were evaluated and managed less aggressively than men.