Exploring the Inclusion of Gender/Sex in Clinical Algorithms: An Analysis of 602 Existing Tools

Gender/sex variables are often included in clinical algorithms, typically without articulating which aspects of gender or sex-linked biologies are hypothesized to contribute to tool output. To date, there exists little systematic evaluation of how gender/sex inputs are used in clinical algorithms. We analyzed all clinical algorithms available on the online database MDCalc, assessing whether and how they include gender/sex inputs. For tools with gender/sex inputs, we evaluated the consequences of, justification provided for, and timeline of including such inputs. Of 602 tools reviewed, 112 (18.6%) included gender/sex, using these inputs to: (1) “adjust” (by directly allocating points according to a change in the gender/sex variable), and (2) “norm” (by using gender/sex to interpret other tool inputs). Less than half of tools included text justifying the inclusion of gender/sex in initial tool development, and only five tools had been updated since initial development. Systematic reconsideration and regular reevaluation of gender/sex inputs in clinical algorithms may be needed to determine which, if any, gender/sex inputs are warranted to support clinicians in providing better care for patients.