Diagnostic Patterns in the Evaluation of Patients Presenting with Syncope at the Emergency or Outpatient Department
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Purpose: Patterns of syncope evaluation vary widely among physicians and hospitals. The aim of this study was to assess current diagnostic patterns and medical costs in the evaluation of patients presenting with syncope at the emergency department (ED) or the outpatient department (OPD) of a referral hospital. Materials and Methods: This study included 171 consecutive patients with syncope, who visited the ED or OPD between January 2009 and July 2009. Results: The ED group had fewer episodes of syncope [2 (1-2) vs. 2 (1-5), p=0.014] and fewer prodromal symptoms (81.5% vs. 93.3%, p=0.018) than the OPD group. Diagnostic tests were more frequently performed in the ED group than in the OPD group (6.2±1.7 vs. 5.3±2.0; p=0.012). In addition, tests with low diagnostic yields were more frequently used in the ED group than in the OPD group. The total cost of syncope evaluation per patient was higher in the ED group than in the OPD group [823000 (440000-1408000) won vs. 420000 (186000-766000) won, p<0.001]. Conclusion: There were some differences in the clinical characteristics of patients and diagnostic patterns in the evaluation of syncope between the ED and the OPD groups. Therefore, a selective diagnostic approach according to the presentation site is needed to improve diagnostic yields and to reduce the time and costs of evaluation of syncope.
Abstract
Purpose: Patterns of syncope evaluation vary widely among physicians and hospitals. The aim of this study was to assess current diagnostic patterns and medical costs in the evaluation of patients presenting with syncope at the emergency department (ED) or the outpatient department (OPD) of a referral hospital. Materials and Methods: This study included 171 consecutive patients with syncope, who visited the ED or OPD between January 2009 and July 2009. Results: The ED group had fewer episodes of syncope [2 (1-2) vs. 2 (1-5), p=0.014] and fewer prodromal symptoms (81.5% vs. 93.3%, p=0.018) than the OPD group. Diagnostic tests were more frequently performed in the ED group than in the OPD group (6.2±1.7 vs. 5.3±2.0; p=0.012). In addition, tests with low diagnostic yields were more frequently used in the ED group than in the OPD group. The total cost of syncope evaluation per patient was higher in the ED group than in the OPD group [823000 (440000-1408000) won vs. 420000 (186000-766000) won, p<0.001]. Conclusion: There were some differences in the clinical characteristics of patients and diagnostic patterns in the evaluation of syncope between the ED and the OPD groups. Therefore, a selective diagnostic approach according to the presentation site is needed to improve diagnostic yields and to reduce the time and costs of evaluation of syncope.
참고문헌 (15)
- Pires LA, "Diagnostic patterns and temporal trends in the evaluation of adult patients hospitalized with syncope", Arch Intern Med, 161, pp.1889~1895 (2001)
- Moya A, "Guidelines for the diagnosis and management of syncope (version 2009)", Eur Heart J, 30, pp.2631~2671 (2009)
- Chen LY, "Management of syncope in adults: an update", Mayo Clin Proc, 83, pp.1280~1293 (2008)
- Kapoor WN, "A prospective evaluation and follow-up of patients with syncope", N Engl J Med, 309, pp.197~204 (1983)
- Brignole M, "Standardized-care pathway vs. usual management of syncope patients presenting as emergencies at general hospitals", Europace, 8, pp.644~650 (2006)
- Kapoor WN, "Evaluation and outcome of patients with syncope", Medicine (Baltimore), 69, pp.160~175 (1990)
- Kapoor WN, "Syncope of unknown origin. The need for a more cost-effective approach to its diagnosis evaluation", JAMA, 247, pp.2687~2691 (1982)
- Brignole M., "Diagnosis and treatment of syncope", Heart, 93, pp.130~136 (2007)
- Brignole M, "Guidelines on management (diagnosis and treatment) of syncope-update 2004. Executive Summary", Eur Heart J, 25, pp.2054~2072 (2004)
- Ammirati F, "Management of syncope: clinical and economic impact of a Syncope Unit", Europace, 10, pp.471~476 (2008)
- Sheldon R, "Diagnostic criteria for vasovagal syncope based on a quantitative history", Eur Heart J, 27, pp.344~350 (2006)
- Steinberg LA, "Syncope in children: diagnostic tests have a high cost and low yield", J Pediatr, 146, pp.355~358 (2005)
- Suzuki T, "Diagnostic patterns in the evaluation of patients hospitalized with syncope", Pacing Clin Electrophysiol, 29, pp.1240~1244 (2006)
- Brignole M, "A new management of syncope: prospective systematic guideline-based evaluation of patients referred urgently to general hospitals", Eur Heart J, 27, pp.76~82 (2006)
- Shen WK, "Syncope Evaluation in the Emergency Department Study (SEEDS): a multidisciplinary approach to syncope management", Circulation, 110, pp.3636~3645 (2004)