title: The DISPARITY Study: do gender differences exist in Surviving Sepsis Campaign resuscitation bundle completion, completion of individual bundle elements, or sepsis mortality?
abstract: OBJECTIVE
  Women in the emergency department are less likely to receive early goal directed therapy, but gender differences in the Surviving Sepsis Campaign (SSC) bundle completion have not been studied [1]. We hypothesized that women have lower SSC resuscitation bundle completion rates.
  
  
  METHODS
  This was a retrospective, observational study in a large urban academic ED at a national SSC site. Consecutive patients (age>18 years) admitted to intensive care with severe sepsis or septic shock and entered into the SSC database from October 2005 to February 2012 were included. Data on overall and individual bundle elements were exported from the database. Bivariate analyses were performed with chi-square tests and t-tests. Multiple logistic regression was then performed with gender as an effect modifier.
  
  
  RESULTS
  Eight hundred fourteen patients were enrolled. The mean age was 66 years;, 44.8% were women. There was no association between gender and bundle completion (aOR 0.83, 95% CI 0.58-1.16), controlling for age, race, Sequential Organ Failure Assessment, congestive heart failure, and coagulopathy. In-hospital mortality did not differ by gender. Women were less likely to receive antibiotics within 3 hours (60.5% vs. 68.8%, p=0.01) and less likely to reach a target ScvO2>70 (31.3% vs. 39.5%, P=.05).
  
  
  CONCLUSIONS
  There were no gender disparities in bundle completion or in-hospital mortality. Further research is needed to examine individual bundle elements and gender specific factors that may affect bundle completion and mortality.
authors.affiliation: Division of Women's Health in Emergency Care, The Alpert Medical School of Brown University, Department of Emergency Medicine, Rhode Island Hospital, Providence, RI; The Alpert Medical School of Brown University, Department of Emergency Medicine, Rhode Island Hospital, Providence, RI. Electronic address: Tracy_Madsen@brown.edu.
authors.forename: Tracy E
authors.initials: TE
authors.lastname: Madsen
authors.affiliation: Boston University School of Medicine, Department of Medicine, Boston Medical Center, Boston, MA.
authors.forename: James
authors.initials: J
authors.lastname: Simmons
authors.affiliation: Division of Women's Health in Emergency Care, The Alpert Medical School of Brown University, Department of Emergency Medicine, Rhode Island Hospital, Providence, RI; The Alpert Medical School of Brown University, Department of Emergency Medicine, Rhode Island Hospital, Providence, RI.
authors.forename: Esther K
authors.initials: EK
authors.lastname: Choo
authors.affiliation: The Alpert Medical School of Brown University, Department of Emergency Medicine, Rhode Island Hospital, Providence, RI.
authors.forename: David
authors.initials: D
authors.lastname: Portelli
authors.affiliation: Division of Women's Health in Emergency Care, The Alpert Medical School of Brown University, Department of Emergency Medicine, Rhode Island Hospital, Providence, RI; The Alpert Medical School of Brown University, Department of Emergency Medicine, Rhode Island Hospital, Providence, RI.
authors.forename: Alyson J
authors.initials: AJ
authors.lastname: McGregor
authors.affiliation: Division of Women's Health in Emergency Care, The Alpert Medical School of Brown University, Department of Emergency Medicine, Rhode Island Hospital, Providence, RI; The Alpert Medical School of Brown University, Department of Emergency Medicine, Rhode Island Hospital, Providence, RI.
authors.forename: Anthony M
authors.initials: AM
authors.lastname: Napoli
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D016009:Chi-Square Distribution; D004636:Emergency Service, Hospital; D005260:Female; D019983:Guideline Adherence; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012151:Resuscitation / Q000401:mortality / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D018805:Sepsis / Q000401:mortality* / Q000628:therapy; D012737:Sex Factors; D063507:Sexism / Q000706:statistics & numerical data; D012772:Shock, Septic / Q000401:mortality
keywords: Gender; Resuscitation bundle; Sepsis; Surviving Sepsis Campaign