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KMID : 0385920110220060662
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Journal of the Korean Society of Emergency Medicine
2011 Volume.22 No. 6 p.662 ~ p.668
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Diagnostic Patterns and Medical Costs in the Evaluation of Syncope Patients Visiting an Emergency Department
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Yoon Hee
Na Ji-Ung
Shin Tae-Gun
Sim Min-Seob
Jo Ik-Joon
Song Hyoung-Gon
Kim June-Soo
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Abstract
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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.
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KEYWORD
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Syncope, Emergency department, Diagnosis, Medical cost
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