Sex Differences in Dispatcher Suspicion of Acute Myocardial Infarction and Mobile Intensive Care Unit Dispatch During Emergency Calls for Chest Pain: A Secondary Analysis of a Prospective Multicentre Cohort.

Abstract Background Sex-related differences may arise at the earliest stages of acute chest-pain assessment. We examined whether recorded sex was associated with dispatcher suspicion of acute myocardial infarction (AMI) and mobile intensive care unit (MICU) dispatch during physician-led emergency medical calls. Methods We performed a secondary analysis of a prospective multicentre cohort of adults hospitalized after calling one of four French physician-staffed emergency medical communication centres for non-traumatic chest pain. Associations between recorded sex and MICU dispatch or dispatcher suspicion of AMI were estimated using modified Poisson regression with sequential adjustment for cardiovascular risk factors and clinical presentation. Adjusted absolute probabilities were obtained by marginal standardization. Using independently adjudicated AMI as the clinical reference, sex-specific sensitivity, specificity, and false-negative rates were also estimated. Results Among 2,042 patients, 993 (48.6%) were female-recorded. AMI occurred in 6.9% of female-recorded and 18.7% of male-recorded patients. Dispatcher suspicion of AMI occurred in 25.1% versus 38.0%, and MICU dispatch in 33.4% versus 46.6%, respectively. After full adjustment, recorded female sex remained associated with lower probabilities of MICU dispatch (adjusted RR 0.85, 95% CI 0.77–0.95) and dispatcher suspicion of AMI (adjusted RR 0.81, 95% CI 0.71–0.92). Adjusted absolute differences were − 6.3 percentage points for both MICU dispatch and dispatcher suspicion. For dispatcher suspicion, sensitivity was 60.6% in female-recorded versus 67.2% in male-recorded patients, while specificity was 77.5% versus 68.7%. For MICU dispatch, sensitivity was 69.6% versus 80.6% and specificity 69.3% versus 61.3%. Conclusions Among hospitalized patients assessed for non-traumatic chest pain, dispatcher suspicion of AMI and MICU dispatch were less frequent among female-recorded patients after accounting for measured clinical characteristics. Both decisions showed higher specificity but numerically lower sensitivity among female-recorded patients; sensitivity differences were imprecisely estimated. These findings describe sex-associated differences in prehospital decision patterns but do not establish inappropriate care or under-triage.