Sex-Related Differences in Suspected Pediatric Anaphylaxis in a Tertiary Hospital Between 2015 and 2022: A Retrospective Cross-Sectional Study and Implications for Nursing Practice.

Background/

Objectives

Anaphylaxis is a severe systemic allergic reaction that may involve multiple organ systems and requires prompt recognition and treatment. In children and adolescents, food is a major trigger, and clinical presentation may vary according to biological factors, including sex. This study aimed to examine sex-related differences in the clinical presentation, triage acuity, measured emergency-care processes, and suspected triggers of anaphylaxis in pediatric patients treated at a tertiary hospital.

Methods

A retrospective cross-sectional study was conducted in the pediatric emergency department of a tertiary hospital in Madrid, Spain, between 2015 and 2022. Sociodemographic characteristics, allergic history, clinical manifestations, TRIPED-GM triage level, Pediatric Assessment Triangle classification, measured emergency-care processes, suspected triggers, hospital admission, and final diagnosis were analyzed. Multiple comparisons were controlled using Bonferroni adjustment within clinically defined domains.

Results

A total of 368 patients were included; 65.2% were boys and 57.3% were aged ≤5 years. Unadjusted analyses identified several apparent signals in specific clinical manifestations, triage distribution, and suspected triggers; none showed a consistent pattern after multiplicity adjustment. The difference in the overall distribution of TRIPED-GM triage levels was not statistically significant after multiplicity adjustment. Although Grade 3 assignment remained more frequent among boys in a category-specific post hoc analysis, this isolated finding was not supported by multivariable ordinal regression, in which sex was not independently associated with overall triage acuity. Tree nuts, cow's milk protein, and egg were the most frequently suspected triggers.

Conclusions

No consistent evidence of overall sex-related differences in suspected pediatric anaphylaxis presentation, measured emergency-care processes, suspected triggers, or triage acuity was found after multiplicity adjustment and multivariable analysis. Although an isolated difference in Grade 3 triage assignment persisted in a post hoc analysis, it should be interpreted cautiously. Pediatric emergency nursing assessment and triage should therefore remain primarily guided by acute clinical presentation and physiological severity rather than by sex. Larger multicenter studies are needed to determine whether more subtle or age-dependent sex-related patterns have clinical relevance.