Assessing Sex Disparities in Rapid Sequence Intubation Procedures in the Emergency Department: Registry Study

Abstract

Rapid sequence intubation (RSI) is critical for airway management in emergency departments (ED). This study investigates sex-based differences in RSI outcomes, exploring how biological, pharmacological and psychosocial factors may influence intubation success and complications. Data from 5021 intubation episodes (January 2010-March 2017) across 42 EDs in Australia and New Zealand was analysed from the ANZEDAR study. Variables including intubation indications, patient factors and complications were stratified by sex. Multivariable logistic regression was used to identify factors associated with first-pass success (FPS) and complications. Males were more frequently intubated for trauma, while females had higher rates of medical indications such as overdose or stroke and had a higher shock index. Males had a higher predicted and observed difficult laryngoscopy and a lower FPS rate. Additionally, males had a higher overall complication rate, and more desaturation events. Females had a higher incidence of mainstem bronchus intubation. Despite a higher predicted difficulty in males, there were no significant differences in clinical practices such as positioning, use of video laryngoscopy or staff seniority. Sex-related differences were observed in this registry, with males experiencing lower FPS and more complications. These findings are exploratory; prospective studies should test whether sex-aware assessment and preparation improve process measures and patient outcomes.