THE ECONOMIC BURDEN OF UNRECOGNIZED VASODEPRESSOR SYNCOPE
THE ECONOMIC BURDEN OF UNRECOGNIZED VASODEPRESSOR SYNCOPE
复制标题
DOI：
10.1016/0002-9343(93)90329-n
复制
发表时间：
1993-11-01
影响因子：
5.9
通讯作者：
MORADY, F
中科院分区：
文献类型：
--
作者：
CALKINS, H;BYRNE, M;MORADY, F
背景：这项研究的目的是描述对有典型血管降压性晕厥病史的晕厥患者进行先前诊断评估的成本。方法和结果。30名连续接受来源不明的晕厥评估的患者参与了这项研究，这些患者的病史高度提示有血管降压性晕厥。在登记期间，这30名患者占158名接受晕厥评估的患者的19%。所有患者的直立倾斜试验结果均为阳性，证实了血管抑制性晕厥的诊断。在评估时，记录了每个患者在转诊前进行的所有诊断测试的类型和结果。在转诊到密歇根大学医学中心之前，平均进行了4+/-2次主要诊断测试。转诊前每个患者的诊断测试的平均成本和中位数分别为3,763+/-3,820美元和2,678美元(范围：0至16,606美元)。6名患者在转诊前未接受主要诊断测试，因此，这些患者的主要诊断测试费用为零。在其余患者中，诊断测试的平均费用和中位数费用分别为4,704美元+/-3,713美元和3,777美元(范围从1,025美元到16,606美元)。结论：这项研究的结果表明，大约20%转诊到大学医院进行不明原因晕厥评估的患者可以在临床上确诊为血管降压性晕厥。未能认识到这些患者的血管降压性晕厥的临床特征导致了高达16,000美元的不必要的诊断测试。因此，更好地了解血管降压剂晕厥的临床特征可能会带来显著的经济节省。
BACKGROUND: The objective of this study was to describe the cost of prior diagnostic evaluation in patients referred for evaluation of syncope whose history was typical of vasodepressor syncope. METHODS AND RESULTS. Thirty consecutive patients who were referred for evaluation of syncope of undetermined origin and whose history was highly suggestive of vasodepressor syncope participated in this study. These 30 patients represented 19% of 158 patients referred for evaluation of syncope during the period of enrollment. All patients had positive results of an upright-tilt test, confirming the diagnosis of vasodepressor syncope. At the time of evaluation, the type and results of all diagnostic tests that had been performed prior to referral were recorded for each patient. The cost of diagnostic testing was then determined based on the 1991 cost of these tests at the University of Michigan Medical Center.A mean of 4 +/- 2 major diagnostic tests were performed before referral to the University of Michigan Medical Center The mean and median costs of diagnostic testing per patient prior to referral were $3,763 +/- 3,820 and $2,678 (range: 0 to $16,606) respectively. Six patients underwent no major diagnostic tests prior to referral and, therefore, the cost of major diagnostic testing was zero in these patients. In the remaining patients, the mean and median costs of diagnostic testing per patient were $4,704 +/- 3,713 and $3,777 (range: $1,025 to $16,606) respectively.CONCLUSIONS: The results of this study demonstrate that a diagnosis of vasodepressor syncope can be established clinically in approximately 20% of patients referred to a university hospital for evaluation of syncope of undetermined origin. Failure to recognize the clinical features of vasodepressor syncope in these patients resulted in up to $16,000 of unnecessary diagnostic testing. A greater awareness of the clinical features of vasodepressor syncope may, therefore, result in significant economic savings.