The influence of gender on ICU admittance

Emma Larsson, Erik Zettersten, Gabriella Jäderling, Anna Ohlsson, Max Bell

We assume that critically ill patients are admitted to an intensive care unit (ICU) based on their illness severity coupled with their co-morbidities. Patient attributes such as religion, nationality, socioeconomic class or gender are not relevant in this setting. We aimed to explore the association of patient gender with admission to the ICU amongst hospital physicians working in Sweden. Primary outcome assessed was gender bias among respondents. Two different versions of an online survey, with eight patient cases, were sent to physicians in Sweden who within their field of specialty meet patients that could be eligible for intensive care. The versions of the survey were identical except that the patient gender in each case was exchanged between the two surveys. Depending on the respondent's birthday (odd or even number) they were directed to one of the two surveys. At the end of each case the respondent was asked to answer if they thought that the patient needed ICU care, yes or no. The respondents were not told in advance about the design of the survey. The respondents were also asked to state their age, sex, field of specialty, size of hospital and title. Of 1426 respondents, 679 and 747 answered survey 1 and 2, respectively. Overall, there were no significant differences in willingness to admit in between cases describing a man or woman in the physician responses. Anesthesiology/intensive care physicians more often choose to admit patients to the ICU compared to all other specialties. Female physicians tended to be more willing to admit patients, regardless of patient gender, than their male counterparts. Using a survey, with eight cases differing only with regards to the gender of the patient, we demonstrate an absence of a gender bias among Swedish hospital physicians.