Patel M, Han S S, Vaux K, Saalfeld J, Alexander J H
Department of Urology, Royal North Shore Hospital, St Leonards, New South Wales, Australia.
Aust N Z J Surg. 2000 Jan;70(1):39-42. doi: 10.1046/j.1440-1622.2000.01740.x.
The recent use of spiral computed tomography (CT) without contrast for the diagnosis of acute flank pain has been shown to be highly sensitive and specific for the detection of urolithiasis. This method has not, however, been evaluated for its contribution to savings in management costs. The present study aims to evaluate the cost savings gained by instituting a protocol of early spiral CT to investigate these patients.
The records of 200 patients presenting to the Accident and Emergency Department (A&E) with acute flank pain during two periods were retrospectively reviewed. The first period was before the spiral CT protocol was instituted and the second was after. Cost analyses between the two periods were performed.
After the spiral CT protocol, 72 versus 31 patients had a definitive diagnosis prior to discharge from hospital. The time taken to diagnosis was also significantly shorter after the protocol implementation (6.3 vs. 16.8 h). This resulted in a shorter time spent in the A&E, and hence bed cost savings. Radiological costs were reduced by 22%, but the major cost saving was made by a reduction in time spent in A&E (44%).
The implementation of a protocol of early spiral CT for patients with suspected renal colic has led to earlier definitive diagnosis and shorter hospital stays. This is associated with a significant reduction in costs associated with managing this condition.
近期研究表明，使用非增强螺旋计算机断层扫描（CT）诊断急性腰痛对尿路结石的检测具有高度敏感性和特异性。然而，该方法对节省管理成本的贡献尚未得到评估。本研究旨在评估通过制定早期螺旋CT方案来检查这些患者所获得的成本节约情况。
回顾性分析了两个时期内200例因急性腰痛就诊于急诊科（A&E）的患者记录。第一个时期是在螺旋CT方案制定之前，第二个时期是在之后。对两个时期进行了成本分析。
在实施螺旋CT方案后，72例患者在出院前得到明确诊断，而之前为31例。方案实施后诊断所需时间也显著缩短（6.3小时对16.8小时）。这导致在急诊科停留时间缩短，从而节省了床位成本。放射学成本降低了22%，但主要的成本节约是通过缩短在急诊科的停留时间实现的（44%）。
对疑似肾绞痛患者实施早期螺旋CT方案可实现更早的明确诊断和更短的住院时间。这与管理该疾病相关成本的显著降低有关。
