실신을 주소로 응급실에 내원한 환자의 진단적 검사 유형과 의료 비용에 대한 연구 (Diagnostic Patterns and Medical Costs in the Evaluation of Syncope Patients Visiting an Emergency Department)

서지정보

· 발행기관 : 대한응급의학회
· 수록지 정보 : 대한응급의학회지 / 22권 / 6호 / 662 ~ 668페이지
· 저자명 : 윤희, 나지웅, 신태건, 심민섭, 조익준, 송형곤, 김준수

초록

Purpose: Syncope is a common clinical problem. However,diagnosis of the cause of syncope is not simple due to a wide variety of forms of syncope. The aim of this study was to assess current diagnostic methods and the associated medical costs which accompany the evaluation of patients suffering syncope who admitted to an emergency department (ED).
Methods: This study is a prospective, observational, single center study. Patients included in the study visited the ED of a single, tertiary hospital between January and December 2009, and were diagnosed with syncope. We investigated the diagnostic yields (DY) for the tests that were employed and evaluated factors related to medical costs.
Results: A total of 124 patients were enrolled in this study.
Blood tests, chest radiography, postural blood pressure (BP) measurement and computerized tomography of the brain were performed in over 60% of cases, but DY for each of these tests was less than 3%, except for postural BP measurement (7.4%). The test which demonstrated a relatively high DY was the head-up tilt test (68.1%). The ratio of the cost of each test among the total medical costs required by all patients (constituent ratio) was highest for brain imaging tests (12.2%). The total cost of syncope evaluation per patient was 1,454,000±2,865,000 won. Factors including hospital admission and diagnosis of cardiac syncope resulted in significantly higher total medical costs for those patients.
Conclusion: Among the tests performed in the ED for syncope evaluation, blood tests, chest x-ray and brain imaging tests were commonly used but resulted in relatively low diagnostic yield. Independent factors which increased medical costs were hospital admission and diagnosis of cardiac syncope.

영어초록

Purpose: Syncope is a common clinical problem. However,diagnosis of the cause of syncope is not simple due to a wide variety of forms of syncope. The aim of this study was to assess current diagnostic methods and the associated medical costs which accompany the evaluation of patients suffering syncope who admitted to an emergency department (ED).
Methods: This study is a prospective, observational, single center study. Patients included in the study visited the ED of a single, tertiary hospital between January and December 2009, and were diagnosed with syncope. We investigated the diagnostic yields (DY) for the tests that were employed and evaluated factors related to medical costs.
Results: A total of 124 patients were enrolled in this study.
Blood tests, chest radiography, postural blood pressure (BP) measurement and computerized tomography of the brain were performed in over 60% of cases, but DY for each of these tests was less than 3%, except for postural BP measurement (7.4%). The test which demonstrated a relatively high DY was the head-up tilt test (68.1%). The ratio of the cost of each test among the total medical costs required by all patients (constituent ratio) was highest for brain imaging tests (12.2%). The total cost of syncope evaluation per patient was 1,454,000±2,865,000 won. Factors including hospital admission and diagnosis of cardiac syncope resulted in significantly higher total medical costs for those patients.
Conclusion: Among the tests performed in the ED for syncope evaluation, blood tests, chest x-ray and brain imaging tests were commonly used but resulted in relatively low diagnostic yield. Independent factors which increased medical costs were hospital admission and diagnosis of cardiac syncope.

참고자료

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