Gender influences on clinical decisions in pediatric emergency department headache visits

Introduction: Limited data exist on sex- and gender-related differences in pediatric emergency care. This study assessed sex-related differences in patient presentation and diagnosis and examined gender-related influences on provider management of adolescents presenting with headaches to the PED. Methods: A retrospective observational cohort review was conducted of patients aged 10–17 years who presented to the Pediatric Emergency Department (PED) with headache-related complaints between 2010 and 2022. The data included demographics, diagnosis, tests and consultations performed, hospitalization, readmission, time to discharge, and admitting physician gender. Results: Over 13 years, 1915 PED visits were recorded, of which 998 (52.1 %) were for females. Female patients were more likely to be referred to a subspecialist (14.3 % vs. 10.3 %; CI 12.2–16.7 % / 8.4–12.4 %, p = 0.028), particularly ophthalmology (p = 0.042). Overall, providers were more likely to direct female patients to a specialist (p = 0.009), regardless of provider gender. No differences were found in the order of ancillary laboratory or imaging tests. Women providers were more likely to order blood chemistry tests (p = 0.042) and psychiatric consultations (p = 0.002), and their patients had longer PED stays with difference in length of stay: 0.15 day [95 % CI -0.30-0.00]). Male patients treated by man providers had higher odds of return visits compared to males treated by women providers (OR 2.00; 95 % CI: 1.08–4.07). Conclusion: Minor differences were observed in the assessment of male and female adolescents. Women healthcare providers were more likely to utilize more PED resources and conduct longer evaluations, which correlated with fewer revisit rates. These findings suggest potential gender related influences on provider decision making.