Women half as likely to be given drug for fatal bleeds (Times report 19/05/22)

[BettyFilous]

Depressing read. Shocking, but not surprising.

Women are half as likely to receive a drug that stops them bleeding to death after accidents as men are due to NHS “sex discrimination”, a study indicated.

www.thetimes.co.uk/article/40789da4-d6cc-11ec-8585-951ab3afb4d2?shareToken=5743b6e44091870815b07a44d3997f52

(MNHQ - do not move to Feminism Chat. The article refers frequently to sex differences in treatment.)

This is the original study

pubmed.ncbi.nlm.nih.gov/35504646/

One possible reason may be the causes of trauma are different in women (more falls) than men (road traffic accidents) and they may not be recognised as needing txa.

Yes, as Sylfia said.

It's also interesting that the effect is particularly pronounced in older women. Particular misogyny towards older women or again to do with the type of trauma? Maybe both?

It's not rocket science to think a woman might need it after a fall though, is it. You'd think it would be a staple.

I remember my mother who attended A&E for similar issues both sides of 60 saying the dropof interest in treating her symptoms once she crossed that line was palpable

Have put a link in AIBU in case anyone thinks it's useful to boost it - better get to.work now

www.mumsnet.com/talk/am_i_being_unreasonable/4552378-to-tell-you-about-tranexamic-acid-txa-could-stop-you-bleeding-to-death-but-women-arent-getting-it

That's the one about different types of accident not TXA, I think.

It's also interesting that the effect is particularly pronounced in older women. Particular misogyny towards older women or again to do with the type of trauma? Maybe both?

Yes I think it's multfactorial, but that doesn't mean it isn't potentially discrimination.

From the paper:

We selected injured patients aged ≥16 yr with an Injury Severity Score (ISS) of 9 or more. This population represents a major trauma population at risk of haemorrhagic death with at least one serious injury.

There's a threshold and some criteria that account for the mechanism of injury (BATT score).

Although there are sex differences in injury mechanisms, we did not control for injury mechanism in our analysis as this would lead to over-adjustment bias. For people with the same risk of death from bleeding, mechanism of injury should not influence the receipt of TXA treatment.
…
Women are treated less frequently than men regardless of their risk of death from bleeding (BATT score) or the severity of their injuries. When women and men with the same mechanism of injury and ISS are compared, women are again treated less frequently than men.

This is disturbing. It looks like women are being let down at every stage at the process. I see the argument above that we may need to know about this in order to advocate for ourselves or family members and I still find this dispiriting for all of the other opportunities that are missed in the overall treatment journey.

That's the one about different types of accident not TXA, I think

Oops I thought Dr Nutbeam looked at treatment and outcomes too - I was sure he mentioned it in the BBC interview.

Totally agree, but if it's primarily to do with lack of recognition that the type of trauma suffered by women may need treatment with txa, then this may be addressed more easily with education of HCPs.

I think that would definitely help. Also auditing them on it as a quality improvement measure.

I wonder what the threshold is for administering TXA? If it's based on estimated blood loss, do they account for size and sex differences? As an average sized woman has approximately 9pints and an average man, approximately 12.

A 20% blood loss for a man will therefore 'look' more serious than for a woman (2.4pts v 1.8pts), so there may be a need for HCP to overcome unconscious bias from a visual assessment of the severity.

Or, as others have pointed out, if blood pressure is the trigger, has there been enough research to understand women's blood pressure at for instance: different ages, different points during their menstrual cycle, or even as a response to trauma?

Sadly we know that sex disaggregated research is a rarity and as a result we are too often treated as if we are simply smaller men (or worse, exactly the same as men).

This is RIDICULOUS, and surely undermines the findings and their credibility?! How can we make changes is someone somewhere doesn't actually have accurate sex markers?

"The Trauma Audit and Research Network (TARN) data set includes sex as recorded on the hospital notes and may represent either sex assigned at birth or gender."

www.ncbi.nlm.nih.gov/pmc/articles/PMC9066497/

FFS. I am more than disappointed.

So from that quote, they are saying that either women (county kind) OR men who feel like women, run these same health risks?!

Course they're not, but because of the most insane obfuscation of legal documents we can't rightly say.

This is an important point, but I guess they would say that the same cultural issues might apply to passing males if their sex was not known (which of course it would be in the majority of cases, even if not recorded).

Actually this is a really interesting point in getting to the bottom of different sexed based outcomes

If transwomen have the same poor outcomes as women then that points to mysoginistic treatment practices e.g. doctors treating women worse simply because they are women

If transwomen have better outcomes than women then that points to women being treated like men when they have different medical requirements

Of course its a very high level comparison not taking into account how easily transwomen can be identified as such etc

Yes I agree this data should ideally be disaggregated where possible to learn about this.

And, to facilitate that, most medical journals are signatories to SAGER guidelines. It's a shame that they don't enforce them.

Sex and gender differences are often overlooked in research design, study implementation and scientific reporting, as well as in general science communication. This oversight limits the generalizability of research findings and their applicability to clinical practice, in particular for women but also for men. This article describes the rationale for an international set of guidelines to encourage a more systematic approach to the reporting of sex and gender in research across disciplines.

Heidari S, Babor TF, De Castro P, Tort S, Curno M. Sex and Gender Equity in Research: rationale for the SAGER guidelines and recommended use. Res Integr Peer Rev. 2016 May 3;1:2. doi: 10.1186/s41073-016-0007-6. PMID: 29451543; PMCID: PMC5793986.

researchintegrityjournal.biomedcentral.com/articles/10.1186/s41073-016-0007-6

I'm not sure how relevant this may be; but transexmic acid is used quite often for haemophiliacs when they have a minor bleed. Haemophiliacs are overwhelmingly male with a very small percentage carrying the gene on both the X and Y chromosome.

I think putting this down to "sex discrimination" is really irresponsible and also dangerous.

What they have discovered is a disparity, and they don't really know why it is happening. It's important that they find out.

Saying that the reason is sex discrimination is what in my old job we called "situating the estimate" - it will tend to result in certain kinds of enquries that may not be the best path to get real results, or any results.

I really doubt there are large numbers of emergency HCPs who are giving necessary drugs to men rather than women on purpose. It's possible that it's related to their ideas about something like women being more whiny, so they discount their complaints. But also totally possible that women with serious injuries are presenting in some way differently so that the cues the HCPs are looking for are not there. Or, something totally different.

But naming a reason speculativly like that is not helpful.

I really doubt there are large numbers of emergency HCPs who are giving necessary drugs to men rather than women on purpose.

As the report acknowledges. Maybe read it?

Not if there are risks as well, and I imagine there are with a drug like that.

In which case the claim that it's discrimination is unwarranted. Unless they are taking the view that any disparity is caused by discrimination, but that would be crazy in a medical context. It's either discrimination, or they don't know the cause, not both.

If it's caused by disregarding situations that affect women more, it may constitute indirect sex discrimination. It's not just direct.